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MED 2031 Wks 7-12 > Renal issues > Flashcards

Renal issues Flashcards

1
Q

prerenal

acute renal failure

A

problem with blood getting into kidney

CAUSES OF PRE-RENAL FAILURE:
•	Hypovolaemia (-due to vomiting, diarrhea, dehydration, haemorrhage etc)
•	Triple whammy
•	Hypotention
•	Shock
•	Renal artery stenosis
•	Etc
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2
Q

renal

acute renal failure

A

any process that is damaging kidney eg toxin, inflammation, necrosis

• ATN!! Most common ccause of renal failure
ATN=death of tubular epithelial cells
• Interstitial: Acute interstitial nephritis.
• Glomerular: GN, diabetic nephropathy
• Vascular: hypertension, polyarteritis, Haemolytic uraemic syndrome, TTP, and vasculitis.

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3
Q

Postrenal

Acute renal failure

A

blocking outflow to kidney eg kidney stones, congenital PUJ obstruction

  • A post-renal obstruction can occur anywhere from the renal pelvis to the urethra, and in order to cause an AKI, the obstruction must be bilateral, or occur in a patient with a solitary kidney).
    • Intraluminal: Renal calculi. (kidney stone)
    • Intramural: Retroperitoneal fibrosis, or strictures (narrowing of tube).
    • Extramural: Benign prostatic hyperplasia, or malignancy.
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4
Q

Whats the best test for postrenal problem

A

imaging

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5
Q

Waths the best test for renal problem

A

urinalysis

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6
Q

Wats the best test for prerenal problem

A

pt assessment

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7
Q

Oliguria

A

lower than 400 mls of urine per day

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8
Q

the worse the kidney function,

A

the higher the serum creatinine level

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9
Q

kidney has a high reserve- u have to lose like 50% of kidney function before see

A

rise in serum creatinine

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10
Q

wen u only have 10% of renal function

A

= end stage renal failure

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11
Q

wen u have 15% renal function

A

get uraemia (urea in the blood)

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12
Q

These are the things that suggest CHRONIC RENAL FAILURE

A

anaemia
renal bone disease
small kidneys
peripheral neuropathy

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13
Q

Haemolysis

A

premature destruction of red cells

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14
Q

septicaemic shock

A

can get MICROANGIOPATHIC HAEMOLYSIS

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15
Q

2 feautres indicate MICROANGIOPATHIC HAEMOLYSIS

A

red cell fragmentation n

platelets decreasing

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16
Q

EFFECTIVE CIRCULATING VOLUME DEPLETION

A

this is where the volume state may be normal, high or low, but renal perfusion is reduced
circulation may be normal but u get all these problems like odema or low cardiac output

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17
Q

radiological hallmark of postrenal ARF

A

hydronephrosis

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18
Q

Diabetic nephropathy

A

its hallmark is albuminuria

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19
Q

Glomerulonephritis

A

• = inflammation of the glomeruli –due to immune issues

collection of diseases

20
Q

glomerulonephritis

DIFFUSE

A

pathology in all glom

21
Q

glomerulonephritis

FOCAL

A

pathology in some glom

22
Q

glomerulonephritis

SEGMENTAL

A

pathology in part of the glom

23
Q

glomerulonephritis

CENTRALLY

A

pathology in in mesangium

24
Q

glomerulonephritis

PERIPHERALLY

A

patholgoy in cappilary loops/glom basement membrane (GBM)

25
Q

Classical presentations of Glomerulonephritis

A

Nephritic syndrome
• Nephrotic syndrome
• Rapidly progressive GN

26
Q

azotaemia

A

build up of wastes in blood- seen in AKF

27
Q

triple whammy

A

3 things that can precipitate kidney injury e.g. AKF

NSAIDs – Vasoconstriction of afferent arteriole-decrease GFR
ACE Inhibitors – Vasodilation of efferent arteriole-decrease GFR
Diuretics –blood volume-Reduced renal blood flow

28
Q

NEPHROTIC SYNDROME:

A

• Defined as Proteinuria > 3.5g/day

  • Get
  • heavy proteinuria (+++)
  • hypoalbuminaemia-Damage to podocytes, proteins can leak through= proteinuria, hypoalbuminaemia
  • hyperlipidaemia-
  • Oedema
  • Hypogammaglobulinaemia: increases infection risk
  • Hyper-coagulable state: loss of AT3
29
Q

NEPHRITIC SYNDROME

A

• Defined as Haematuria with red cell casts and dysmorphic RBCs

  • Get
  • Haematuria (++)
  • Proteinuria (
30
Q

RAPID PROGRESSIVE GLOMERULONEPRITIS

A

caused by
SLE-lupus nephritis
ANCA-anti-neutrophil cytoplasmic antibodies
• Goodpasture’s syndrome- aka Anti-glomerular basement glomerulonephritis aka anti-GBM disease.

31
Q

• SLE- lupus nephritis

A

systemic autoimmunity, 90% young females, immunomodulatory drugs

32
Q

DISEASE ON THE SIDE OF NEPHROTIC SYNDROME On the SPECTRUM

A

minimal change disease
• FOCAL SEGMENTAL GLOMERULOSCLEROSIS
• MEMBRANOUS GN
• DIABETIC NEPHROPATHY

33
Q

• MINIMAL CHANGE DISEASE:

A

under light mirco-looks normal, electronmicroscope-podocyte changes. In kids. Treat with prednisolone

34
Q

• FOCAL SEGMENTAL GLOMERULOSCLEROSIS

A

see sclerosis under light microscope. sclerosis to some parts of some glom. In adults. Doesn’t respond to prednisolone.

35
Q

• MEMBRANOUS GN

A

autoimmune disease. in adults. 1/3 Remit, 1/3 Progress, 1/3 ESKD. Prednisolone with cyclosphamide

36
Q

DISEASE ON THE SIDE OF THE NEPHRITC SYNDROME

A 
•	POST-STREP GLOMERULONEPHRITIS 
•	IGA GN
•	GOOD PASTURE’S DISEASE/ANTI-GBM disease
•	ANCA VACULITIS
SLE 
•	ALPORT’s SYNDROME
37
Q

• POST-STREP GLOMERULONEPHRITIS

A

presents 2/3 wks (eg hematuria) after post Strep pyogenes infection (eg. Pharngitis). Children. So after infection, theres immunity that accidentally ruins kidneys. Lots of antibodies. Treat:remove antigen

38
Q

• IGA NEPHROPATHY

A

presents alongside mucosal infection (eg gastro/URTI (upper resp tract infec)). IGA in mesangium-mesangial proliferation. Most commonest cause of GN/microscopic haematuria

39
Q

• GOOD PASTURE’S DISEASE/ANTI-GBM disease

A

Auto-antibodies to type 4 collagen in glomerular and alveolar basement membranes; haemoptysis/lung haemorrhage + haematuria. Glgom crescent.

40
Q

• ANCA VACULITIS

A

glom crescent formation. Antibodies bind to neutrophils causing vasculitis (inflam of blood vessels)

41
Q

• ALPORT’s SYNDROME-

A

Hereditary defect in type 4 collagen; haematuria, sensorineural impairment, cataracts

42
Q

microscopic haematuria, mesangial proliferation

Buzzword

A

= IGA nephropathy

43
Q

autoimmune

buzzword

A

membranous GN

44
Q

glomerular crescent formation

buzzword

A 
any rapidly progressive GN
ANCA GN (or good pastures)
45
Q

kidney is innocent bystander

buzzwrod

A

post-infectious GN

46
Q

progressive GN with LUNG HAEMORRHAGE/haematuria +haemoptysis

buzzowrd

A

good pastures

MED 2031 Wks 7-12 (13 decks)

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