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Julia PCP2 > Kidney > Flashcards

Flashcards in Kidney Deck (22):
1

Name 2 surrogates that are used for diagnosis of AKI?

Serum creatinine, urine ouptut

2

What are the 4 main physiological manifestations of kidney dysfunction?

-Na+/water imbalance
-Accumulation of solutes & wastes
-Accumulation of acids
-Abnormalities of endocrine function

3

How long does recovery from acute ATN usually take?

2-6 weeks

4

What are the investigations in the clinical assessment of AKI?

ABG, ECG, UEC, calcium, phosphate, FBE, ESR/CRP, coags, LFTs, CK, urinalysis, urine MCS, urine albumin/creatinine ratio, U/S kidneys

5

What are the STOP causes of AKI?

S - sepsis/hypoperfusion
T - toxin
O - obstruction
P - parenchymal disease

6

Outline management considerations for AKI (6 marks).

1. Discontinue offending agents & nephrotoxins
2. Meticulous volume status assessment
3. Measure urea, creatinine, other electrolytes & venous bicarbonate daily
4. Daily weighs, fluid chart, regular obs & fluid assessments
5. Nephrology input to gauge the need for dialysis
6. Loop diuretics if applicable for volume overload

7

What is the definition of chronic kidney disease?

-eGFR 3 months with or without evidence of kidney damage
OR
-evidence of kidney damage for >3 months - eg/ haematuria, proteinuria, pathological or anatomical abnormalities

8

What are 5 clinical manifestations of CKD?

-Urine change - anuria, oliguria, nocturia, polyuria
-Oedema
-Frothy urine (proteinuria)
-Fatigue, SOB, pallor (anaemia)
-Generalised weakness
-Nausea & anorexia
-Pruritus
-Constipation
-Fractures

9

Name 5 investigations you would perform if you suspect CKD and why.

1. Urine MCS - to rule out infection as a cause for symptoms
2. Urine albumin:creatinine ratio - to determine the degree of renal damage
3. UEC - to determine eGFR & electrolyte imbalances
4. HbA1c - if applicable
5. U/S kidneys - to look for structural abnormalities

10

What is the target BP for patients with CKD?

130/80mmHg
OR
125/75mmHg in proteinuria/diabetics

11

What are 3 medications proven to be effective at reducing proteinuria?

-ACE inhibitors
-ARBs
-Spironolactone

12

Outline the management of CKD (6 marks).

-Identify & treat the underlying cause
-Reduce further progression of kidney disease
-Reduce CV risk
-Early detection & management of metabolic complications
-Medication adjustment/avoidance of renally excreted & nephrotoxic medications

13

What is the definition of nephrotic syndrome?

Proteinuria >3.5g/day

14

What is the definition of nephritic syndrome?

Haematuria ± proteinuria

15

What part of the kidney is required for biopsy - the cortex of medulla?

The cortex

16

What part of the glomerulus is disrupted (seen on EM only) in minimal change disease?

The podocytes (epithelial cells)

17

What is the mainstay of treatment of minimal change disease?

Steroids

18

How long after the precipitating infection does IgA nephropathy usually manifest?

Approx 10 days

19

What are the histologic findings in IgA nephropathy?

Mesangial proliferative glomerulonephritis with segmental lesions & crescents

20

cANCA and pANCA relate to which vasculitides?

cANCA = Wegener's granulomatosis
pANCA = microscopic polyangiitis

21

How does microscopic polyangiitis manifest itself besides renal failure?

Progressive skin rash
Fever
Myalgia or arthralgia
Weight loss
SOB

22

What histologic feature is characteristic of diabetic nephropathy?

Kimmelstiel-Wilson nodules (nodular sclerosis)