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MBBS I CPRS > L79 - Acute and Chronic Kidney failure > Flashcards

L79 - Acute and Chronic Kidney failure Flashcards

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1
Q

Kidney failure causes can be categorized into which 3 categories?

A

– Pre-renal
– Intra-renal
– Post-renal

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2
Q

What does GFR measure?

What is the normal GFR and rate of decline?

A

Standard measurement of
renal function

Normal GFR ~ 100-125 ml/min/1.73 m2

Declines by 1 ml/min/1.73m2 per year

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3
Q

What are the K/DOQI Classification for the 5 stages of CKD according to GFR?

A
  1. Kidney structural damage with normal or higher GFR ~ >=90
  2. Kidney damage with mild ↓ in GFR ~ 60-89
  3. Moderate ↓in GFR ~ 30-59
  4. Severe in ↓ GFR ~ 15-29
  5. Kidney Failure ~ <15 or dialysis
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4
Q

Give 2 main groups of pre-renal causes of kidney dysfunction?

A

1) HYPOperfusion

2) Renovascular diseases

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5
Q

Name some Pre-renal causes due to Hypoperfusion?

A

– Hypovolemia (GIB/dehydration)
– Septic shock
– Cardiogenic shock

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6
Q

Name some Pre-renal causes due to Renovascular diseases?

A

Renal artery stenosis

Renal artery/ vein thrombosis

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7
Q

Intra-renal causes of kidney failure?

A
  • Drugs
  • Glomerulonephritis
  • Acute tubular necrosis/ obstruction
  • Metabolic diseases

(infection and allergic rxns)

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8
Q

Name some drugs that causes Drug-induced nephrotoxicity?

A

NASIDs
Antimicrobials
Iodine contrast (used in angiograms, sacns…)

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9
Q

Name some antimicrobials that directly cause Drug-induced nephrotoxicity, some with indirect action?

A

Direct:

  • Aminoglycoside/foascarnet/amphoB
  • Adefovir/tenofovir

Indirect:
- Penicillin/rifampicin

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10
Q

How does – Penicillin/rifampicin cause Drug-induced nephrotoxicity?

A

Trigger abnormal immune response

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11
Q

Most common cause of End stage renal disease?

A

Diabetes mellitus nephropathy

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12
Q

What is Diabetes mellitus nephropathy associated with?

A

Other microvascular complications&raquo_space; retinopathy, neuropathy

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13
Q

Compare the cause of Type I and II Diabetes, and the expected time span until renal failure?

A

1) Type 1 = autoimmune destruction of Islet cells
10 years to EDRD

2) Type 2 = metabolic unresponsiveness to insulin
15-20 years to ESRD

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14
Q

Apart from Diabetes mellitus nephropathy, name other glomerular diseases?

A

Hypertensive nephrosclerosis
Malignant nephrosclerosis

Hereditary nephropathies (e.g. Alport’s syndrome, Adult polycystic kidney disease)

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15
Q

What is adult polycystic kidney disease associated with?

A

Cerebral aneurysm > Intracerebral hemorrhage

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16
Q

Compare nephrotic and nephritic syndrome in glomerulonephritis: Renal impairment?

A

Renal impairment
Nephritis = Usually present
Nephrotic= present or not

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17
Q

Compare nephrotic and nephritic syndrome in glomerulonephritis: Proteinuria

A 
Nephritis = ++
Nephrotic= +++ (>3g/DAY LOSS)
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18
Q

Compare nephrotic and nephritic syndrome in glomerulonephritis: Microscopic
hematuria

A 
Nephritis = ++
Nephrotic= present or not
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19
Q

Compare nephrotic and nephritic syndrome in glomerulonephritis: Other associated features

A 
Nephritis = Hypertension 
Nephrotic= Edema, hyperlipidemia, Hypoalbuminemia
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20
Q

Is this disease nephiritc or nephrotic:Anti-GBM disease ?

A

Nephritic

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21
Q

Is this disease nephiritc or nephrotic: FSGS?

A

Nephrotic

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22
Q

Is this disease nephiritc or nephrotic: Minimal change disease?

A

Nephrotic

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23
Q

Is this disease nephiritc or nephrotic: IgA Nephropathy?

A

Nephritic

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24
Q

Is this disease nephiritc or nephrotic: Post-infectious GN?

A

Nephritic

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25
Is this disease nephiritc or nephrotic: Membranous GN?
Nephrotic
26
Is this disease nephiritc or nephrotic: Amyloidosis?
Nephrotic
27
Is this disease nephiritc or nephrotic:Lupus nephritis?
Nephritic
28
Is this disease nephiritc or nephrotic: ANCA-vasculitis?
Nephritic
29
Is this disease nephiritc or nephrotic: | Membranoproliferative glomerulonephritis?
Nephritic
30
Give 4 causes of secondary Glomerulonephritis?
Autoimmune disorders Infections Malignancy Some drugs
31
What are the 3 ways to assess renal biopsy?
Light microscopy Immunofluorecense Electron microscopy
32
What is the general treatment for GN?
ACE inhibitor | Angiotensin receptor blocker
33
Which type of Nephrotic syndrome is only diagnosed with EM histology?
Minimal change disease
34
Acute/Chronic interstitial nephritis is commonly related to what?
Commonly related to drugs (e.g. rifampicin, allopurinol, NSAIDs, PPI)
35
What is the interstitial infiltrate of Acute/Chronic interstitial nephritis?
Interstitial infiltrates >> usually mononuclear cells with occ. eosinophils)
36
Name two causes of Acute/Chronic interstitial nephritis other than drugs?
– Infection (e.g. hanta virus, leptospirosis) – Autoimmune disease (e.g. SLE, Sjogren)
37
Name 4 causes of Intra-renal tubular obstruction?
Light chain cast nephropathy Rhabdomylosis (myoglobin) (e.g. limb ischemic, crush syndrome) Crystallization due to acyclovir (anti-herpes drug) Urinary stones
38
What is the most common cause of acute kidney injury?
Acute tubular necrosis Usually due to acute ischemic/toxic event
39
What are the 3 pahses of acute tubular necrosis?
Initiation (acute drop of GFR; sudden rise in serum urea & Creatinine) Maintenance (oliguric/non-oliguric) Recovery (polyuric phase)
40
Recovery of acute tubular necrosis?
Usually recovers within 1-2 wks; can be up to | 4-6 wks
41
What is Post renal causes of kidney failure associated with?
Renal impairment is usually associated with BILATERAL obstruction
42
Which structures can be abnormal and cause post-renal problems?
* Prostate/urethra * Urinary bladder * Ureter
43
What is the Most common cause of bilateral hydronephrosis in men?
BPH | Benign prostate hyperplasia
44
Some symptoms of BPH? Due to what?
Hesitancy/ urinary frequency/ weak stream Due to growth of prostate blocking flow of urine from bladder to urethra
45
What test is used to diagnose prostate cancer?
PSA test >> measure level of prostate-specific antigen in serum >> done every year from 40 years old onwards (+ digital rectal exam)
46
Lower UTI must result in renal impairment. True or false?
False Lower UTI seldom results in renal impairment
47
Give 2 causes of urethral problems, which becomes post renal cause of kidney disease?
Urethral stenosis/stricture due to Previous trauma or prolonged catheterization
48
What can CA bladder cause?
– Painless gross hematuria | – Can cause bilateral ureteric obstruction
49
Symptoms of bladder stones?
Dysuria/hematuria/recurrent | UTI
50
Name some EXTRAmural ureteric problems?
– Metastatic Lymph nodes – Post-radiation fibrosis – Idiopathic retroperitoneal fibrosis (rare autoimmune)
51
Name an intramural ureteric problem?
CA ureter
52
General symptoms of renal failure?
``` – Malaise – Pruritus – Anorexia – Nausea – Vomiting ```
53
Urinary problems in renal failure?
– Polyuria, nocturia
54
Cardiovascular problems of renal failure?
– Ankle edema; pulmonary edema – Hypertension, cardiomegaly – Uremic pericarditis
55
Neurological problems of renal failure?
– Restless legs – Hiccups – Confusion and seizure (uremic encephalopathy) – Carpel tunnel syndrome (β2-microglobulin amyloidosis)
56
Hematological problems of renal failure?
– NcNc anemia (Normochromic, normocyticanemia) >> reduced erythropoietin production – Bleeding tendency >> platelet dysfunction
57
Endocrine problems of renal failure?
``` – Infertility, amenorrhea – Sexual dysfunction – Growth retardation in children – Secondary/ tertiary hyperparathyroidism – Renal osteodystrophy ```
58
How is renal osteodystrophy caused?
Phosphate retention is excessive >> loss of Ca2+ Related to secondary or tertirary hyperthyroidism
59
Electrolyte and acid-base disturbance of renal failure?
– Hyponatremia – Hypocalcemia – Hyperkalemia – Hyperphosphatemia – Metabolic acidosis (usually increased Anion Gap)
60
What are some treatment options for chronic kidney disease?
– Treatment of underlying causes (e.g. DM, GN) – Dietary & lifestyle modifications – Blood pressure control & RAS blockade – Avoid nephrotoxic agents/drugs
61
What are the options for treating end stage renal disease/ failure?
 Renal Replacement Therapy: - Peritoneal Dialysis - Haemodialysis - Kidney Transplantation  Palliative Renal Care

MBBS I CPRS (78 decks)

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