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Renal > General Renal, AKI and CKD > Flashcards

General Renal, AKI and CKD Flashcards

1
Q

Recurrent frank haematuria 1-2 days after an upper respiratory infection

A

IgA nephropathy

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2
Q

Nephritic syndrome (haematuria, fall in GFR, hypertension) 1-3 weeks after an infection

A

Post-infective glomerulonephritis

Typically post-streptococcal

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3
Q

Skin or joint involvement

A

Suggests secondary to underlying condition eg. SLE or vasculitis

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4
Q

Obesity and renal problems

A

Associated with focal segmental glomerulosclerosis

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5
Q

Anti-glomerular basement membrane antibody

A

Goodpastures disease

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6
Q

Anti-neutrophil cytoplasmic antibodies - ANCA

A

Systemic vasculitis

Check for specificity against MPO (myeloperoxidase) or protease 3 (PR3)

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7
Q

Antinuclear antibodies with specificity for ds DNA

Low complement levels

A

SLE

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8
Q

Abnormal lung function tests with renal problems

A

Can be Goodpastures syndrome - blood in alveoli absorbs CO used to measure gas transfer - therefore raises gas transfer coefficient

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9
Q

Other signs of drug-induced acute interstitial nephritis

A

Maculopapular rash, fever or eosinophilia

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10
Q

Symptoms/signs of acute interstitial nephritis

A

May be loin pain from stretching of renal capsule

Mild proteinuria, microscopic haematuria, white blood cells casts and eosinophils in urine

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11
Q

Ultrasound in acute interstitial nephritis

A

Slightly enlarged kidneys

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12
Q

Tubular/interstitial causes of acute kidney injury

A

Drugs (NSAIDs, aminoglycoside antibiotics, ACEi or ARB, PPIs)
Radiological contrast
Rhabdomylosis - myoglobin
Haemolysis - haemoglobin
Systemic/renal infection - infiltration
Gout- excess urate production - urate crystals precipitate in tubules
Tumour lysis syndrome following chemo

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13
Q

Signs of chronic kidney injury

A

Small kidneys

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14
Q

When to refer kidney injury to nephrologist

A

Hyperkalaemia in oligoanuric patient,
Hyperkalaemia or fluid overload not reponsive to medical treatment
Urea >40
Suspected glomerulonephritis (blood or protein on urinalysis)

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15
Q

Signs of glomerular disease on urine dip

A

Protein or blood

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16
Q

Presence of Bence Jones proteins in urine

A

Myeloma

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17
Q

General management of AKI

A

Aim for euvolaemia

Stop nephrotoxic drugs (NSAIDs, ACEi, gentamicin, amphotericin, metformin if creatinine >150)

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18
Q

Management of pre-renal AKI

A

Correct volume depletion
Treat sepsis
If shock - consider ITU

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19
Q

Management of post-renal AKI

A

Catheterise
CT of renal tract if needs be
Urology referral if obstruction

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20
Q

Management of intrinsic renal AKI

A

Refer to nephrology if glomerulonephritis or tubulointerstitial disease suspected

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21
Q

Management of uraemia in AKI

A

May need dialysis if severe or complications eg. encephalopathy, pericarditis

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22
Q

Management of acidaemia in AKI

A

Sodium bicarbonate PO or IV

23
Q

Management of hyperkalaemia in AKI

A

Give calcium gluconate (cardioprotective)
Give insulin and glucose - get K+ into cells
Salbutamol same affect as insulin/glucose but more needed and tachycardia is a risk
If acidotic - give sodium bicarbonate

24
Q

Definition of Chronic Kidney Disease

A

Impaired renal function >3 months based on abnormal structure or function
or GFR 3 months without evidence of kidney damage

25
Q

Classification of CKD

A

Done according to GFR

26
Q

Stage 1 CKD

A

> 90ml/min - therefore normal but with evidence of renal damage eg. proteinuria or haematuria

27
Q

Stage 2 CKD

A

60-89
Slight decrease with signs of renal damage
IF ALL kidney tests are normal at this GFR then there is no CKD

28
Q

Stage 3 CKD

A

30-59 - with or without signs of renal damage

29
Q

Stage 4 CKD

A

15-29 with or without

30
Q

Stage 5 CKD

A

Below 15

31
Q

End stage renal failure

A

GFR

32
Q

Causes of CKD x5

A 
Diabetes- type 2 more than type 1 
Glomerulonephritis 
Unknown 
Hypertension or renovascular disease 
Pyelonephritis
33
Q

Screening for CKD in which patients

A 
AT RISK 
HTN 
DM 
CVD
Structural renal disease 
Recurrent UTIs
Multisystem disorders eg. SLE 
Family history of ESRF
34
Q

Hx in CKD - looking for cause

A

PMHx of risk factors
DHx
FHx
Systems review for systemic disorder or malignancy

35
Q

Hx in CKD - current state

A

Uraemic symptoms - anorexia, vomiting, restless legs, fatigue, weakness, pruritus, bone pain
Women - amenorrhea
Men - impotence

36
Q

Examination of CKD

A 
Pallor
Uraemic tinge - yellow
Purpura and excoriations
HTN 
Cardiomegaly
37
Q

Signs of bone problems in CKD

A

Renal bone disease - bone pain, especially in lower back, hips and legs
Often associated with proximal myopathy and soft tissue calcification

38
Q

Haemotological complications of CKD

A

Anaemia - inadequate erythropoietin production
Therefore give erythropoietin SC or IV - only works if iron, folate and B12 are normal

Bleeding times increased - can give synthetic vasopressin (desmopressin) to transiently reduce bleeding time

39
Q

Vascular complications in CKD

A

Many have DM
Also hypertension - hypervolemia from salt and water retention
Or due to excess renin production

40
Q

Skin complication in CKD

A

Itch - calcium phosphate deposition in skin

Also ureamia- can get uremic frost

41
Q

GIT in CKD

A

Peptic ulcer no more common in CKD
but gastrin elevated - nausea, vomiting, anorexia and heartburn
Higher incidence of oesophagitis and angiodysplasia

42
Q

Endo in CKD

A

Men - loss of libido, impotence and low sperm count

Women - loss of libido, reduced ovulation and infertility

43
Q

Immunological in CKD

A

Function is impaired in severe CKD and infection common

Uremia suppresses function of immune cells

44
Q

Lipid in CKD

A

Hyperlipidaemia - higher in patients on peritoneal dialysis than haemolysis

45
Q

Cardiac in CKD

A

Pericarditis can occur and more likely if urea or phosphate are high
Fluid overload and HTN - left ventricular hypertrophy or dilated cardiomyopathy

46
Q

Management of CKD

A

Restrict dietary potassium, phosphate and sodium and water

BP management
Treat complications

47
Q

Neuro in CKD

A

Cramps, restless legs
Peripheral neuropathy
Myopathy
Depression and anxiety

48
Q

Fused podocytes on electron microscopy - proliferative or non-proliferative glomerulonephritis

A

Non-proliferative

49
Q

Syndrome caused by proliferative and non-proliferative glomerulonephritis

A 
Proliferative = nephritic syndrome
Non-proliferative = nephrotic syndrome
50
Q

What do you see on electron microscopy of rapidly progressive glomerulonephritis

A

Crescents

eg. goodpastures and systemic vasculitis

51
Q

What do you see on electron microscopy of membranous IgA nephropathy

A

thickening of glomerular basement membrane

52
Q

How is Alports syndrome inherited?

A

X-linked dominant usually

53
Q

Most common and important infective agent in transplant of solid organs

A

CMV

Renal (9 decks)

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