Zero to Finals Flashcards
What is the classic triad of HUS?
Haemolytic anaemia
Acute kidney injury
Low platelet count (thrombocytopenia).
What are the ECG changes for hyperkalamia?
(MUST KNOW)
An ECG is required in all patients with a potassium above 6 mmol/L. It is worth memorising the ECG changes in hyperkalaemia:
Tall peaked T waves
Flattening or absence of P waves
Broad QRS complexes
What are the indications for Dialysis?
A – Acidosis (severe and not responding to treatment)
E – Electrolyte abnormalities (severe and unresponsive hyperkalaemia)
I – Intoxication (overdose of certain medications)
O – Oedema (severe and unresponsive pulmonary oedema)
U – Uraemia symptoms such as seizures or reduced consciousness.
End stage renal failure (CKD stage 5)
What are the 3 options for long term dialysis?
Continuous Ambulatory Peritoneal Dialysis
Automated Peritoneal Dialysis
Haemodialysis
What are the complications of peritoneal dialysis?
Bacterial peritonitis. Infusions of glucose solution make the peritoneum a great place for bacterial growth. Bacterial infection is a common and potentially serious complication of peritoneal dialysis.
Peritoneal sclerosis involves thickening and scarring of the peritoneal membrane.
Ultrafiltration failure can develop. This occurs when the patient starts to absorb the dextrose in the filtration solution. This reduces the filtration gradient making ultrafiltration less effective. This becomes more prominent over time.
Weight gain can occur as they absorb the carbohydrates in the dextrose solution.
Psychosocial effects. There are huge social and psychological effects of having to change dialysis solution and sleep with a machine every night.
Summary of Haemodialysis:
With haemodialysis, patients have their blood filtered by a haemodialysis machine. Regimes can vary but a typical regime might be 4 hours a day for 3 days a week.
They need good access to an abundant blood supply. The options for this are:
Tunnelled cuffed catheter
Arterio-venous fistula
What are the main complications with using a catheter for haemodialysis?
The main complications are infection and blood clots within the catheter.
What are the complications of AV fistulas?
Aneurysm
Infection
Thrombosis
Stenosis
STEAL syndrome
High output heart failure
What is STEAL syndrome?
STEAL syndrome is where there is inadequate blood flow to the limb distal to the AV fistula. The AV fistula “steals” blood from the distal limb. The blood is diverted away from where is was supposed to supply and flows straight into the venous system. This causes distal ischaemia.
What is meant by nephritic syndrome?
Nephritic syndrome or acute nephritic syndrome refers to a group of symptoms, not a diagnosis. When we say a patient has “nephritic syndrome” it simply means they fit a clinical picture of having inflammation of their kidney and it does not represent a specific diagnosis or give the underlying cause. Unlike nephrotic syndrome, there are no set criteria. However, there are the following features in nephritic syndrome:
Haematuria means blood in the urine. This can be microscopic (not visible) or macroscopic (visible).
Oliguria means there is a significantly reduced urine output.
Proteinuria is protein in the urine. In nephritic syndrome, there is less than 3g / 24 hours. Any more and it starts being classified as nephrotic syndrome.
Fluid retention
To have nephrotic syndrome a patient must fulfil what criteria:
Peripheral oedema
Proteinuria more than 3g / 24 hours
Serum albumin less than 25g / L
Hypercholesterolaemia
What is meant by glomerulonephritis?
e.g…
Glomerulonephritis is an umbrella term applied to conditions that cause inflammation of or around the glomerulus and nephron.
e.g Interstitial nephritis &glomerulosclerosis
Interstitial nephritis
Interstitial nephritis is a term to describe a situation where there is inflammation of the space between cells and tubules (the interstitium) within the kidney. It is important not to confuse this with glomerulonephritis. Under the umbrella term of interstitial nephritis, there are two key specific diagnoses: acute interstitial nephritis and chronic tubulointerstitial nephritis. These are discussed in a later section.
Glomerulosclerosis is a term to describe the pathological process of scarring of the tissue in the glomerulus. It is not a diagnosis in itself and is more a term used to describe the damage and scarring done by other diagnoses. Glomerulosclerosis can be caused by any type of glomerulonephritis or obstructive uropathy (blockage of urine outflow), and by a specific disease called focal segmental glomerulosclerosis.
Glomerulosclerosis
Most types of glomerulonephritis are treated with what?
Immunosuppression (e.g. steroids)
Blood pressure control by blocking the renin-angiotensin system (i.e. ACE inhibitors or angiotensin-II receptor blockers)
Goodpasture syndrome:
Anti-GBM (glomerular basement membrane) antibodies attack glomerulus and pulmonary basement membranes. This causes glomerulonephritis and pulmonary haemorrhage. In your exam, there may be a patient that presents with acute kidney failure and haemoptysis (coughing up blood).
If you come across a patient in your exam with the combination of acute renal failure and haemoptysis, think of two conditions: Goodpasture syndrome and granulomatosis with polyangiitis (AKA Wegener’s granulomatosis). Goodpasture syndrome is associated with anti-GBM antibodies, whereas Wegener’s granulomatosis is a type of vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA). Patients with Wegener’s granulomatosis may also have a wheeze, sinusitis and a saddle-shaped nose.
If you come across a patient in your exam with the combination of acute renal failure and haemoptysis, think of two conditions: Goodpasture syndrome and granulomatosis with polyangiitis (AKA Wegener’s granulomatosis). Goodpasture syndrome is associated with anti-GBM antibodies, whereas Wegener’s granulomatosis is a type of vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA). Patients with Wegener’s granulomatosis may also have a wheeze, sinusitis and a saddle-shaped nose.
What is diabetic nephropathy and what does it lead to?
Diabetic nephropathy is the most common cause of glomerular pathology and chronic kidney disease in the UK. The chronic high level of glucose passing through the glomerulus causes scarring. This is called glomerulosclerosis.
Proteinuria is a key feature of diabetic nephropathy. This is due to damage to the glomerulus allowing protein to be filtered from blood to urine.
Patients with diabetes should have regular screening for diabetic nephropathy by testing the albumin:creatinine ratio and U&Es.
How is diabetic nephropathy managed?
Treatment is by optimising blood sugar levels and blood pressure.
ACE inhibitors are the treatment of choice in diabetics for blood pressure control. They should be started in patients with diabetic nephropathy even if they have a normal blood pressure.
What is meant by interstitial nephritis?
Interstitial nephritis is term to describe a situation where there is inflammation of the space between cells and tubules (the interstitium) within the kidney. This is different to glomerulonephritis, where there is inflammation around the glomerulus. There are two types of interstitial nephritis: acute interstitial nephritis and chronic tubulointerstitial nephritis.
What is acute interstitial nephritis and what is it usually caused by?
Acute interstitial nephritis presents with acute kidney injury and hypertension. There is acute inflammation of the tubules and interstitium. This is usually caused by a hypersensitivity reaction to:
Drugs e.g NSAIDS / antibiotics
Infection
Note: You may also see rash / fever / eosinophillia in the paitent (associated with the hypersensitivity).
