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Clinical Medicine > Renal > Flashcards

Renal Flashcards

1
Q

Criteria for Actute Kidney Injury?

A

Rise in creatinine ≥ 25 micromol/L in 48 hours

Rise in creatinine ≥ 50% in 7 days

Urine output of <.5mL/kg/hour for more than 6 hours

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2
Q

Risk factors for AKI?

A

Chronic kidney disease

Heart Failure

Liver disease

Diabetes

Nephotoxic medication

Contract agents (CT Scans)

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3
Q

Causes of Acute Renal Injury?

A

Pre-RenalMost common casue of AKI, due to inadequate blood supply to kidneys reducing filtration :
* Dehydration
* Hypotension (Shock)
* Heart Failute

Renal: instic causes => reduced filtradtion of blood
* Glomerular Nephritis
* Interstitial nephritis
* Acute tubular necrosis

Post-Renal: obstruction to outflow of urine from kidney
- Kidney Stones
- Masses (Cancers inabdo/pelvis)
- Ureter/Uretral strictures
- Enlarged prostate/prostate cancer

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4
Q

Investigations/Differential for Acute Renal Injury

A

Urinaysis for protein, blood, leucocytes, nitrates and glucose
- Leucocytes + Nitrates => Infection
- Protein + Blood => Acute nephritis (or Infection)
- Glucose => Diabetes

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5
Q

Management of AKI?

A

Fluid rehydration (Pre-renal cause)

Stop nephrotxoic medicaitons (NSAIDs/anithypertensives that reduce filtration pressure)

Relieve obstruction (Post-renal AKI)

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6
Q

Causes of Chronic Kidney Disease?

A

Diabtetes

Hyeprtension

Glomoerulonephritis

Polycystic Kidney Disease

NSAIDS/PPI/Lithium

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7
Q

Presentation of AKI?

A

Pruritis (ithcing)

Loss of apetitie

Nasuea

Edema

Muscle cramps

Peripheral Neuropathy

Pallor

Hypertension

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8
Q

Investigations for CKD?

A

eGFR: Checked via U/E blood test (2 required 3 months apart to diagnose CKD)

Protenuria: checked w/ urine albumin:creatinine ratio (>3 Significatnt)

Hematura: Urine dipstick (significant +1)

Renal Ultrasound

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9
Q

Management of CKD?

A

Atorvostatin for prevention of cardiovascular

ACE inhibitors

To limit complications
* Oral Sodium bicarbonate (Metobolic acidosis)
* Iron suppmentation (Anemia)- kidneys produce EPO
* Vit D (Renal bone disease)
* Dialysis (End stage)
* Renal Transplant

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10
Q

Complications of CKD?

A

Hypertension (Treated w/ ACE inhibitor)

Anemia

Renal Bone DIsease:
* high serum phosphate occurs due to reduced excretion
* low vitamin D bc kidney is essential to metabolizing vitamin D to its active form => low serum calcium
* Secondary hyperparathyroidism bc [parathyroids react to low serum calcium and high phosphate by excreting more PTH

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11
Q

Indications for Dialysis?

A

A- Acidosis (Severe/unresponsive to treatment)

E - Electrolyte abnormalities (Severe/unresponsive HYPERKALEMIA)

I - Intoxication (overdose of medication)

O - Oedema (severe/unresponsive pulmonary edema)

U - Urameia (Seizures/reduced consciousness)

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12
Q

Options for Hemodialysis?

A

Tunneled cuffed catheter: tube inserted into subclavian or jugular vein with a tip into the superior vena cava. Has two lumens one where blood exits the body (red) and one where blood enters the body (blue). Complications are infection/clots

AV Fistula: Bypasses capilary system allows for a permanent, l arge, easy access blood vessel w/ high pressure arterial blood flow. Requires surgery and a 4 week to 4 month maturation period. Typically performed between Radio-Cephalic or Brachio-Cephalic

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13
Q

Examination/Complications of an AV Fistula?

A

Typically performed between Radio-Cephalic or Brachio-Cephalic

Examination:
- Skin integrity
- Anuerysms
- Palpable Thrill
- Machinery murmur on ausclatation

Complications
- Anerrysm
- Infection
- Thrombosis
- Stenosis
- STEAL Syndrome: Inadeqwute blood flow to limb distal of ASV fistula => distal ischemia
- High output heart failure: Increased pre-load to heart=> Hypertrophy of heart muscle

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14
Q

Classification of Nephritic Syndrome?

A

Nephritic, unlike nephrotic has no set criteria however includes:
- Hematuria (Microscopic or Macroscopic)
- Oliguria
- Protenuria (< 3 g per 24 hours of Urine)
- Fluid Retention

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15
Q

Classification of Nephrotic Syndrome?

A

Nephrotic MUST fulfill the following:
- Peripheral Edema
- Protenuria (> 3 g per 24 hours of Urine)
- Serum Albumin < 25g per L
- Hypercholestermeia

Usually present with Edema, Frothy Urine (Protinurea)

Predispoisition to thrombosis, hypertension, high cholesterol

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16
Q

Treatment of Glomerulonephritis?

A

Immuosupression (Steroids)

Blood Pressure control (ACE/ARBs)

17
Q

Most common cause of nephrotic syndrome in children?

A

Minimal Change Disease
(Idiopathic, treated sucessfully w/ steroids)

18
Q

Most commone cause of Nephrotic Syndrome in Adults?

A

Focal Segmental Glomerulosclerosis

19
Q

Most common cause of primary glomerulonephritis?

Demographic? Histology?

A

IgA Nephropathy (Berger’s Disease)
- Peak presentation is in the 20’s
- Histology shows IgA deposits and mesangial proliferation

20
Q

Most common type of glomerulonephritis overall?

Demographic? Histology?

A

Mebranous Glomerulonephritis
- Bimodal peak in 20’s and 60’s
- Histology shows IgG and complement deposition on basement membrane
- ~70% indiopathic
- Can be secondary to maligannagyy, rheumatoid disease, NSAIDs

21
Q

Presentation of post-streptococoal glomerulonephritis?

A
  • Typically <30
  • 1-3 weeks after streptococoal infection (tonsilitis/impetigo)
  • Usually full recovery
22
Q

Patient presenting with acute kidney failure + hemoptysis

A

Goodpasture’s Syndrome: Anti-GBM (Glomerular basement membrane) anitbodies attack glomerulus/pulmonary basement membranes => glomerulonephritis and pulmonary hemmorage

23
Q

Most common cause of glomerular pathology + CKD?

Pathophysiology? Associated signs? Screening? Management?

A

Diabetic Nephropathy
- High levels of glucose passing through glomerulus => scarring (Glomerulosclerosis)
- Protinuria (Damage allows protein to be filtered from blood into urine)
- Albumin::Creatine ratio screening + U&Es
- Optomise blood sugars/BP. All should be put on ACE Inhibitors

24
Q

Manifestation of Acute Instersitial Kidney Disease

A

Usually casued by hypersensitivity reaction to Drugs/Infection

Presents w/ fever, rash, eosinophillia

25
Q

Causes of Acute Tubular Necrosis?

Presentation on Histology?

A

Damage and death of epithelial cells of the renal tubules and most common casue of acute kidney injury. Occurs due to ischemia or toxins

Ischemic Causes:
- Shock
- Sepsis
- Dehydration

Toxin Causes:
- Radiology Contrast Dye
- Gentamycin
- NSAIDs
- Lithium
- Heroin

Muddy Brown Casts (Pathogmonic)

26
Q

Kidney histology shows IgG and complement deposition on basement membrane?

A

Mebranous Glomerulonephritis
- Bimodal peak in 20’s and 60’s
- Most common type of glomerulonephritis overall
- ~70% indiopathic
- Can be secondary to maligannagyy, rheumatoid disease, NSAIDs

27
Q

Kidney histology shows IgA deposits and mesangial proliferation?

A

IgA Nephropathy (Berger’s Disease)
- Peak presentation is in the 20’s
- Histology shows IgA deposits and mesangial proliferation

28
Q

Kidney histology shows muddy brown casts?

A

Acute Tubular Necrosis

Ischemic Causes:
- Shock
- Sepsis
- Dehydration

Toxin Causes:
- Radiology Contrast Dye
- Gentamycin
- NSAIDs
- Lithium
- Heroin

29
Q

Type 1 Renal Tubular Acidosis

Pathology? Causes? Presentation? Results? Treatment?

A

Acidosis due to pathology in the distal tubule (Unable to excrete hydrogen ions)

Causes:
- Genetic
- Lupus
- Sjorgens
- PBC

Presentation
- Failure to thrive in children
- Hyperventilation
- CKD
- Osteomalacia

Results
- HYPOKalemia
- Metabolic acidosis
- High Urinary pH

Treatment: Oral Bicarbonate

30
Q

Type 4 Renal Tubular Acidosis?

Pathology? Causes? Results Treatment?

A

Acidosis due to reduced aldosterone => hyperkalemic renal tubular acidosis=> reduced excretion of ammonia => acidic urine

Due to adrenal insufficiency, ACE Inhibitor/Spiralactone or Lupus/Diabetes

Results
- Hyperkalemia
- High Chloride
- Metabolic Acidosis
- Low urinary pH

Treated with Fluticortisone

31
Q

Rhadomuolysis constituents released/risks?

A

Skeletal muscle breaks down in response to extremee undeuse/overuse/traumatic injury releasing:
- Myoglobin
- Potassiium
- Phosphate
- Creatinine Kinase (thousands to hundreds of thousands)

Risks:
- Hyperkalemia => cardiac arythmia/cardiac arrrest

32
Q

Investigations for Hyperkalemia?

A

U&Es
- Creatinine
- Urea
- eGFR
- Hemolyss of RBC during sampling can result in falsely elevated potassium

ECG Signs
- Tall peaked T waves
- Flattening or absence of P Waves
- Broad QRS

33
Q

Management of Hyperkalemia?

A

Potassium < 6mmol don’t need urgent management

Potassium > 6mmol + ECG need urgent management

Potassium > 6.5mmol need urgent management regardless of ECG

Mainstay of treatment:
- Insulin and dextrose infusion: drives K+ into cells
- Calcium Gluconate: stanilizes cardiac myocytes and reduces risk of arrythmia
- Nebuluized Salbutomol temporaily drives K+ into cells
- Dialysis in SEVERE cases ass w/ renal failure

34
Q

Extrarenal manifestations of Polycystic Kidney Disease?

A

Cerebral Aneurisms
Hepatic/Pancreatic/ovarian cysts
Cardiac Valve disease
Colonic Diverticula

Clinical Medicine (8 decks)

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