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Flashcards in kidney diseases Deck (66)
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1

what is acute kidney injury

rapid decrease in kidney function/GFR
causes build up of uric acid, urea, ammonia, creatinine, lack of ECF and electrolyte control

2

what can cause AKI

pre-renal
- hypotension (haemorrhage, shock, burns)
- dehydration
- hypoperfusion from NSAIDs
renal
- glomerulonephritis
- interstitial nephritis
- acute tubular necrosis
post - renal
- abdominal or pelvic masses
- ureter constriction
- kidney stones
- prostatic enlargement

3

what are risk factors for AKI

diabetes
heart failure
chronic kidney disease
heart failure
65+
nephrotoxic drugs
contrast medium

4

how does AKI present

nausea
vomiting
flank pain
confusion
drowsiness
dehydration
oliguria
diarrhoea

5

what investigations would you do for AKI

urinalysis
bloods
creatinine
US for stones
renal biopsy

6

what are creatinine and oliguria values in AKI

creatinine of more than 25micromoles/l in 48 hrs
creatinine increase of 50% in 7 days
urine output of less than 0.5mg/kg/hr for > 6hrs

7

how do you treat AKI

pre-renal - rehydration, IV fluids
renal - refer, dialysis, transplant
post-renal - remove stone/obstruction
avoid nephrotoxic drugs
monitor electrolytes

8

what are complications of AKI

hyperkalaemia
metabolic acidosis
fluid overload
uraemia

9

what is chronic kidney disease

irreversible damage to the kidneys causing progressive decline in function
hyperfiltration through remaining glomeruli causes hypertrophy and hyperplasia

10

what causes chronic kidney disease

diabetes
hypertension
AKI
malignancy
polycystic kidney disease
renal stones
(any renal disease can cause CKD)

11

what are risk factors for CKD

diabetes
hypertension
smoking
age
black
asian

12

how does CKD present

insidious disease - only presents in later stages
lethargy
oedema
loss of appetite
pallor
puritis
muscle cramping
oliguria
anaemia
hypertension

13

what investigations could you do for CKD

kidney biopsy
urinalysis
US for obstruction
eGFR

14

how could you manage CKD

control hypertension and diabetes
refer to renal - dialysis, transplant
treat acidosis

15

what is polycystic kidney disease

genetic disorder
cysts in kidney impair function and compress blood vessels causing hypertension (increased renin release) and ischaemia/necrosis

16

what causes PKD

genetics
PKD-1 gene - more severe
PKD - 2 gene

17

what are the types of PKD and which is more common

ARPKD
ADPKD
dominant is more common

18

how does ADPKD present

cysts elsewhere - pancreas, liver, ovaries
hypertension
berry aneurysms (+SAH)
mitral regurgitation
flank masses
pain
hepatomegaly

19

how does ARPKD present

presents in infants
renal failure in womb - oliguria - oligohydramnios - lung under-development
respiratory infection
portal hypertension
caput medusae
oesophageal varices

20

what investigations do you do in PKD

US - infants
CT
MRI
genetic testing

21

how do you treat ADPKD

analgesics
surgical drainage
tolvaptan
manage hypertension
dialysis
transplant

22

how do you manage ARPKD

ventilation
surgical drainage
antibiotics
diuretics

23

what is UTI

urinary tract infection

24

what are common UTI pathogens

staph A
e.coli
enterococcus
klebsiella

25

what else can cause UTIs

catheters
poor hygiene
sexual activity

26

what are risk factors for UTI

risk increases with age
young, sexually active women
menopause
pregnancy
diabetes
urine stasis - stones, stricture, neurogenic bladder

27

how does UTI present

dysuria
frequency
urgency
offensive cloudy urine
flank/suprapubic pain
upper UTI may also have fever/chills, haematuria, pain

28

what investigations could you do for UTI

MSSU
urinalysis
urine dipstick
US
IV urography if recurrent

29

how do you manage UTI

advice - drink fluids, void after sex, heat therapy
give abx - amoxicillin or cephalosporin

30

what are complications of UTI

pyelonephritis - sudden severe kidney inflammation

31

what is diabetic nephropathy

damage to the glomerulus due to hyperglycaemia
leads to glomerulosclerosis
proteins can leak through into the filtrate

32

what causes diabetic nephropathy

poorly controlled T1 or T2DM

33

how does diabetic nephropathy present

asymptomatic
GFR decreases causing end stage renal disease
proteinuria

34

what investigations would you do in diabetic nephropathy

screening of diabetics - look for albumin in urine microalbuminuria in early stagers, macro in late
biopsy - kimmelsteil wilson lesions, damaged podocytes
eGFR
albumin/creatinine ratio

35

how do you manage diabetic nephropathy

blood pressure and blood glucose control

36

what is interstitial kidney disease

inflammation of the interstitium - space between the nephrons and glomerulus
can be acute or chronic

37

what causes interstitial kidney disease

acute - NSAIDs, antibiotics, hypersensitivity
chronic - autoimmune disease, infection, granulomatosis disease

38

how does interstitial kidney disease present

acute IKD presents with AKI and hypertension

39

how do you manage interstitial kidney disease

treat underlying cause and give steroids

40

what is acute tubular necrosis

death/destruction of the tubule cells
most common cause of AKI

41

what can cause acute tubular necrosis

hypoperfusion - sepsis, shock, dehydration
toxins - NSAIDs, contrast dyes, gentamycin

42

what investigations would you do for acute tubular necrosis

urinalysis - muddy brown casts
only found in this disease!

43

how do you manage acute tubular necrosis

the cells replace themselves
remove underlying cause
rehydration with IV fluids
stop toxins
should get better in 7-21 days

44

what is renal tubule acidosis
describe type I and IV

metabolic acidosis because of tubule pathology
type I - distal tubule can't excrete H
type IV - reduced aldosterone causing decreased Na resorption, hyperkalaemia, acidosis, increased K inhibits ammonia production

45

what causes type I renal tubule acidosis

genetics
hyperthyroidism
sjoren's syndrome
sickle cell anaemia
marfan's
lupus

46

what causes type IV renal tubule acidosis

addison's disease (hypoaldosterism)
lupus
diabetes
HIV

47

how does renal tubule acidosis present
(type 1&4)

1 - failure to thrive, hyperventilation, osteomalacia (use up bicarbonate from bone), hypokalaemia because K binds to bicarbonate
4 - hyperkalaemia, high chloride, low urinary pH

48

what investigations do you do in renal tubule acidosis

K levels for hyperkalaemia/hypokalaemia

49

how do you treat type 1 RTA

oral bicarbonate to neutralise H

50

how do you treat type 4 RTA

fludrocortisone
sodium bicarbonate
treat hyperkalaemia with insulin, dextrose, calcium gluconate or 2nd line is salbutamol

51

what is haemolytic uremic syndrome

triad of haemolytic anaemia, thrombocytopenia and acute kidney injury

52

what can cause HUS

e.coli toxin

53

how does HUS present

easy bruising
purpura
oliguria
haematuria
abdominal pain
hypertension
oedema
lethargy
irritability
confusion

54

how do you treat HUS

control BP
fluid balance
blood transfusions

55

what are kidney stones

solid lumps usually of calcium oxalate or phosphate due to solutes in urine moving into kidneys and solidifying
usually form in kidneys but can form in rest of urinary tract

56

where are common places for kidney stones to lodge

renal pelvis
abdo-pelvic junction
vesicoureteral junction
bladder neck

57

risk factors for kidney stones

hypercalcaemia
hyperparathyroidism
hyperuricaemia
male

58

how do kidney stones present

if in upper urinary tract may be asymptomatic as other kidney functions fine
dull bilateral flank pain
renal colicky pain
dysuria
haematuria
pyrexia

59

what investigations can you do for renal stones

CT
urinalysis
urogram
US

60

how do you treat kidney stones

if they are less than 5mm they will pass themselves in a few hours
hydration
analgesics
shock wave lithotripsy
percutaneous nephrolithotomy
open surgery
potassium citrate to prevent precipitation

61

what is acute urinary retention

painful inability to void

62

what are clinical signs of acute and chronic urinary retention

palpable percussible bladder

63

what is chronic urinary retention

painless inability to void/incomplete voiding with LUTS

64

what LUTS might happen in chronic urinary retention

poor stream
hesitancy
incomplete emptying
nocturnuria
incontinence

65

how do you treat acute urinary retention

catheterisation
find and treat underlying cause

66

how do you treat chronic urinary retention

don't need to if it's asymptomatic + low residual volume
clean intermittent self catheterisation
long term catheter if unsuitable for CISC