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Acute Renal Failure Flashcards

0
Q

Frothy urine is indicative of which renal abnormalities

A

Proteinuria such as in nephrotic syndrome

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1
Q

Recurrent frank haematoma is indicative of what

A

IgA glomerulonephritis in young people

Renal tract cancer in elderly people

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2
Q

Haematuria at the beginning of the urine stream is suggestive of what

A

Urethral bleeding

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3
Q

Haematuria at the end of the urine stream is suggestive of what

A

Bladder or prostate bleeding

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4
Q

Haematuria throughout the urine stream is suggestive of what

A

Glomerular bleeding

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5
Q

What can happen in the kidneys following a streptococcal throat. Infection

A

Post-infective glomerulonephritis

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6
Q

Dysmorphic red cells in the urine suggest what

A

Glomerular bleeding

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7
Q

Eosinophils and leukocytes in the urine are suggestive of what

A

Interstitial nephritis

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8
Q

Polymorphonuclear cells in the urine suggest what

A

Inflammation from bacterial infection

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9
Q

Red cell casts in the urine suggest what

A

Bleeding usually due to glomerulonephritis

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10
Q

White cell casts in the urine suggest what

A

Acute infection - usually bacterial

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11
Q

What do hyaline or fine granular casts in the urine suggest

A

They are normal findings, but may be raised in proteinuria

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12
Q

Fatty casts in the urine are suggestive of which condition

A

Nephrotic syndrome

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13
Q

Large waxy casts in the urine suggest what

A

Chronic kidney disease

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14
Q

Where are urinary casts made

A

In the DCT and collecting ducts

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15
Q

What are urinary casts primarily made of

A

Tubular mucoprotein aka Tamm-Horsfall protein

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16
Q

Pigmented casts in the urine are suggestive of what

A

Haemoglobinuria or myoglobinuria

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17
Q

Describe the structure of calcium oxalate crystals and which conditions might make them appear in the urine

A

Square envelope shape

Most common component in kidney stones

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18
Q

Describe triple phosphate crystals and when they might be present in the urine

A

Coffin lid shape

Found in alkalin urine eg in a proteus UTI such as klebsiella

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19
Q

Describe the structure of Uric acid crystals and when they would be present in the urine

A

Diamond shape
Found in hyperuricaemia eg in gout
Can also be caused by tumour lysis syndrome

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20
Q

Describe the shape of cystine crystals and when they would be present in the urine

A

Hexagonal with sharp edges

Present in cystinuria (inherited metabolic disorder)

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21
Q

What is the first sign of diabetic nephropathy

A

Microalbuminuria

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22
Q

What might be seen on histology in ATN

A

Dilated tubules
Loss of tubular epithelium
Mitosis figures in tubular epithelial nuclei

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23
Q

What are the histology all features of acute interstitial nephritis

A

Leucocytic infiltrate into the interstitial (esp eosinophils)
Normal glomeruli

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25
Q

What are the histological features of crescentic glomerulonephritis

A

Crescent shaped cluster of acute inflammatory cells w/in the Bowmann’s capsule displacing the glomerular tuft

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26
Q

name the three broad groups of AKI

A

PRERENAL- decr fluid/blood to kidneys so decr GFR
INTRINSIC - damage to parenchyma
POSTRENAL - urinary tract obstruction

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27
Q

which part tof the glomerular vasculature does angiotensin II act

A

it is a powerful vasoconstrictor of the vas efferens

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28
Q

how might third space sequestration cause AKI and how might it manifest

A

PRERENAL - compression of renal veins (if >70mmHg also arteries)

manifests as:

  • resp comprimise
  • decr cardiac output
  • intestinal ischaemia
  • hepatic dysfunction
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29
Q

what is the most common cause of intrinsic ARF

A

acute tubular necrosis

30
Q

how does rhabdomyolysis cause AKI

A

haem from myoglobin damages proximal tubules, and obstructs tubules as forms casts.
volume depletetion may also occur as fluid accumulates within the damaged muscles.

31
Q

what 4 electrolyte abnormalities are present in rhabdomyolysis

A

hyperkalaemia
hyperphosphataemia
hyperuricaemia
hypocalcaemia as calcium is deposited in muscle (hyper in recovery as this is released)

32
Q

describe three methods of preventing rhabdomyolysis induced AKI

A

fluid repletion
forced alkaline diuresis
mannitol forced diuresis

33
Q

how can radiocontrast nephropathy be preventd

A 
low osmolarity contrast media 
prehydration with IV fluids
antioxidants
N-acetyl-cysteine
diuretics
IV NaCO3
34
Q

name three types of ATIN

A

drug induced
infection related
inflammatory

35
Q

whihc drugs can cause ATIN

A 
penecillins
cephalosporins
sulfonamides
rifampicin
frusemide
NSAIDs
36
Q

which viral infection can cause ATIN

A

Hautavirus

37
Q

name a bacterial infection which can cause ATIN

A 
legionella
leptospira
streptococci
mycoplasma
brucella
chlamydia
38
Q

which inflammatory conditions are associated with ATIN

A

Sjogrens
SLE
Wegener’s granulomatosis
sarcoidosis

39
Q

which type of ATIN presents with eosinophiluria and eosinophilia

A

drug induced

40
Q

which type of ATIN might present with neutrophilic cellular infiltrate

A

infection induced from acute pyelonephritis

41
Q

what is TINU syndrome

A

uveitis with TIN
usually presents in childhood
in adults more common in females
thought to be related to autoantibodies to CRP

42
Q

which is the main diagnostic test for post renal causes of AKI

A

US

looks for hydronephros or hydroureter

43
Q

what are the main tubular functions in the kidney

A

concentration of urine
acidification of urine

therefore in obstruction there is a loss of concentration and a loss of acidification capacity leading to polyuria and metabolic acidosis

44
Q

what are the treatments of post renal AKI

A

post obstructive diuresis
replace electrolytes
correct metabolic acidosis

45
Q

what is a normal anion gap acidosis indicative of and what might have caused is

A

bicarbonate loss

caused by diarrhoea and renal tubular acidosis

46
Q

what is an increased anion gap suggestive of and what might have caused it

A

increased acid production

caused by:

  • lactic acidosis
  • DKA
  • renal failure
  • methanol
  • ethylene glycol
47
Q

what are the signs of metabolic acidosis

A

muscle weakness
altered mental state
kussmaul breathing
hypotension (from negative ionotropic effect)

48
Q

what are the effects of hyperkalaemia

A

muscle weakness
constipation
cardiac : loss of p wave, tall tented T, wide QRS

49
Q

what can be administered IV in hyperkalaemia to protect cardiac muscle

A

Ca gluconate
10mls of 10% over 10 mins
Ca antagonises K in cardiac muscles

Dextrose insulin as glucose co-transported with K

SABA - IV salbutamol works via the glucose K co-transporter

50
Q

what must not be given to patients with bilateral renal artery stenosis

A

ACE inhibitors as causes a dramatic drop in GFR

51
Q

list 4 causes of high renin states

A

1 volume depletion (D&V, diuretics)
2 fluid overload (cirrhosis, nephrotic syndrome)
3 low cardiac output (CCF)
4 renal hypoperfusion (renal artery stenosis)

52
Q

which is the most common causative organism in acute pyelonephritis

A

e. coli

53
Q

what are the three predisposing conditions for papillary necrosis

A

diabetes
urinary tract obstruction
analgaesic abuse

54
Q

list some causes of hyperosmolar hyponatraemia

A

renal failure
hyperglycaemia
mannitol therapy

55
Q

list some causes of hyponatraemia with a normal osmolarity

A

also known as pseudohyponatraemia

seen in severe hyperlipidaemia and paraproteinuria

56
Q

hyposmolar hyponatraemia can be further sub divided into what

A

HIGH ADH

LOW ADH (renal failure, primary polydipsia)

57
Q

what can cause primary polydipsia

A

anti-psychotic induced thirst
hypothalamic lesions
beer drinkers

58
Q

which type of diuretic might be used in hyponatraemia

A

loop diuretics

59
Q

what is osmotic demylination syndrome

A

a complication of rapid correction of severe hyponatraemia

60
Q

what are Bence Jones proteins

A

light chains from IgG found in myeloma

light chain disease can cause cast nephropathy

61
Q

give two examples of osmotic diuretics and what they do

A

mannitol, glycerol

exert an osmotic effect in the glomerulus as they are not reabsorbed

62
Q

give two examples of loop diuretics and what they do

A

furosemide and bumetenide
they bind to NKCC2 co-transporters in the THICK ascending limb, this inhibits Na K and Cl reabsorption which decreases the medullary hypertonicity.

They also alter the transcellular voltage and reduce reposition of calcium and magnesium
THESE ARE STRONG DIURETICS

63
Q

give two examples of thiazide diuretics and how they work

A

bendroflumethazide and indapamide

these reversibly bind inhibit the NCC apical NaCl co-transporter in the DCT allowing more sodium in and potassium out
they are weak diuretics
can raised rate and cholesterol levels
can also lead to the depletion of Na K Cl Mg

64
Q

give two examples of potassium sparing collecting duct diuretics

A

amiloride and triamterene

blocks ENaC and therefore sodium reabsorption and potassium secretion

65
Q

how does aldosterone affect the collecting duct

A

promotes sodium reabsorption and potassium secretion

66
Q

how does spironolactone work?

A

it blocks aldosterone receptors in the collecting duct reducing sodium reabsorption.

can lead to:
hyperkalaemia
gynaecomastia (as anti andrgogenic)

67
Q

list two drugs that can cause hypokalaemia

A

thiazide diuretics

loop diuretics

68
Q

list three drugs that can cause hyperkalaemia

A

ACEI
Angiotensin receptor blockers
sprinoloactone

69
Q

which drugs may cause irreversible renal damage

A

aminoglycosides (Gent)

NSAIDS

70
Q

which drug may falsely elevated serum creatinine

A

trimethoprim

71
Q

which drugs can cause rhabdomyolysis

A 
statins
calcineurin inhibitors ( cyclosporin and tocrolimus)

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