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RENAL > UTIs, AKI, Kidney Syndromes > Flashcards

UTIs, AKI, Kidney Syndromes Flashcards

1
Q

Azotemia

A

Build-up of nitrogenous waste in blood; nitrogen

Can lead to Uraemia if uncontrolled ; Urea in blood

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2
Q

Diagnostic test for kidney function

A

Urea: Creatinine

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3
Q

UTI ( def and types)

A

symptomatic bacterial infection within the urinary tract.

◉LUTI - cystitis (symptomatic infection of the bladder)
◉UUTI - acute pyelonephritis (symptomatic infection of the kidney).

complicated if symptoms of pyelonephritis emerge, or if a UTI is found in certain patient populations - immunosuppressed, men, pregnancy, diabetes

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4
Q

Urinary tract host defence mechanisms

A

◉Urine - acidic PH, High osmolality, flushing
◉Mucosal Immunity - Secretion of cytokines and chemokines, Lining makes penetration difficult, Mucosal IgA, in men :Zinc and urethra is longer

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5
Q

UTI pathogens

A 
E. coli (75-95% of cases)/ uropathogenic E. coli (UPEC)
Proteus mirabilis
Klebsiella pneumoniae
Enterobacter
Staph b (less common)
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6
Q

Invasion of the Urothelium

A

◉Attachment: overcoming host defences, attach to urothelium- aggressive host response= cytokines, inflammation and exfoliation
◉Invasion: Facet cell invasion, influx of neutrophils
◉Intracellular replication: In vesicles in facet cells, host cell exfoliation allowing deeper penetration due to loss of urothelial integrity
◉Intracellular bacterial communities (IBCs) form: secrete toxins and damage host cells
◉Fluxing and Filamentation: Bacteria flux away from IBC and emerge from dying urothelial cells. Filamentous form not recognise by neutrophils. Invade further cells. Persist in quiescent intracellular reservoirs (QIRs).

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7
Q

Risk Factors for UTIs (4cats)

GABI

A

◉Iatrogenic - drugs, catheters
◉Genetics - Familial tendency, altered vaginal mucous properties, susceptible cells
◉Anatomical - Deformity, Female, Pregnant
◉Behavioural - voiding dysfunctions, Freq/recent Intercourse

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8
Q

Pyelonephritis

symptoms

A

◉bacterial infection of the kidney parenchyma
◉risk of bacterial ascension is greatly enhanced when ureteral peristalsis is inhibited (eg, during pregnancy, by obstruction, by endotoxins of gram-negative bacteria)
◉ affected kidney enlarged from inflammation and oedema

Symptoms-
Flank pain
High fever
Malaise
Dysuria
Vomiting
Increased freq and urgency
WBC and Bacteria in urine
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9
Q

Pyelonephritis Complications

A 
Sepsis.
Parenchyma renal scarring. 
Recurrent urinary tract infections.
Renal abscess formation.
Preterm labour in pregnancy.
Emphysematous pyelonephritis.
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10
Q

Investigations and treatment

A

◉midstream or catheter specimen of urine - sensitivity and culture
◉urine dipstick - adjunct

➼ Treatment
Antibiotics - once urine sample obtained
Ciprofloxacin 500 mg BD 7/7; trimethoprim 200mgBD 14/30; co-amoxiclav 500/125 mg TDS for 7-10 days
If pregnant - Cefalexin 500mg BD

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11
Q

Cystitis

Symptoms and Management

A 
Bladder infection
➼ Symptoms
Incr urinary freq
Urgency
Dysuria
Nocturia
supra pubic pain
possible haematuria

in older women - atypically present as delirium/debility (exclude other causes)

<65 Urine dipstick (nitrite, rbc and leukocytes)
Cultures - midstream urine

➼ Treatment

•Selfcare measures -
Advise Fluid intake
Analgesia
•Consider antibiotics based on severity and cultures
1st line - nitrofurantoin 100mg -modified release, or trimethoprim 200mg (if risk of resistance)
•Back up antibiotics -if mild and no risk of complicated. To be used if no improvement in 48hrs

If haematuria - further investigation and referral

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12
Q

AKI

Types

A

An abrupt orrapid decline in renal functionas evidenced by arapid rise in serum creatinineordecrease in urine output
Pre-renal - GFR depressed by compromised renal perfusion
Renal - affecting kidney itself
Post renal - obstruction

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13
Q

Pre renal AKI causes

A
  • Hypovolemia ; diarrhoea, sepsis, inadequate fluid intake
  • Dec Cardiac Output
  • Dec effective circulating volume - CHF, liver failure
  • Impaired renal autoregulation - medications NSAIDs,ACEi/ARBS, Cyclosporine
  • Hypercalcemia
  • RAS - plaque dev or FMD(fibromuscular dysplasia)
  • Hepato renal syndrome - prog elevation of plasma creatinine in advanced liver disease
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14
Q

renal AKI causes

A
  • Glomerulonephritis - inflammation - fluid leakage- reduced pressure diff - low GFR
  • Vasculitis - obstructions or destruction
  • ATN ( ischaemic and toxic ; pigments : rhabdomyolysis, haeme, Drugs; Amp B, Aminoglycosides, Contrast induced -vasoconstrictive)
  • AIN acute interstitial nephritis ( drug allergies - sulfa drugs,B lactams, PPIs
  • TTP-HUS
  • Malignant hypertension
  • Sepsis
  • Nephrotoxins - Amphotericin B, PPIs, NSAIDs, Rhabdomyolysis, Haemolysis, Myeloma
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15
Q

Post renal AKI causes

A

Bladder outlet obstruction

Bilateral/Unilateral Pelvoureteral obstruction

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16
Q

AKI clinical features

A
  • Hypotension - refractory •tachycardia
  • Oliguria
  • Fluid overload
  • Nephritic syndrome
  • Flank pain
  • Maculopapular rash and fever
  • Uraemic encephalopathy, pericarditis, bleeding
  • Malaise/palpitations
  • Nausea, vomiting, abdominal pain, altered appetite, muscle weakness and decreased visual acuity

➼ Management

Dialysis
Fluid correction - loop diuretics
Acidosis correction - HCO3 admin
Hyperkalaemia -Potassium binders, red in dietary intake

17
Q

Renal Syndromes

A

◉Nephritic Syndrome - manifestation of glomerular inflammation
Acute - rise in serum creatinine over weeks or less
Chronic - over years
also
primary - IgA nephropathy (deposition of IgA immune complexes), Membranoproliferative GN
Secondary - Post infection (streptococcal - group A (S.pyrogenes)), autoimmune disease, connective tissue disorders

➼  Symptoms
Haematuria
Azotaemia
Proteinuria
Oliguria
HTN
Blurred vision
Mild oedema
➼ Management
Bed rest
Diet restriction - salt, K, fluid
HTN meds 
Anti-inflammatory meds
Diuretics
Dialysis is severe

◉ Nephrotic Syndrome
Kidney disease causing Protenuria, Hypoalbuminaemia and Oedema

Damage to podocytes - proteins enter filtrate
Loss of AT3 - Hypercoagulable state

•Primary
x Minimal change disease (~75%) seen in children
x Membrano-proliferative GN
x Focal segmental glomerulosclerosis

•Secondary
x SLE 
x Malignancy
x Infections - Hep b, c,HIV,malaria
x Diabetic Nephropathy
➼  Symptoms
Proteinuria
Frothy urine
Hypoalbuminemia
Oedema
Hyperlipidaemia
Hypercoagulability/thrombosis
➼ Management
Steroids
ACEi/ARBS - protenuria
Dietary restriction
Diuretucs
Statins
only treat hypercoaguability if DVT develops

RENAL (3 decks)

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