L79 - Acute and Chronic Kidney failure Flashcards Preview

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Flashcards in L79 - Acute and Chronic Kidney failure Deck (61):
1

Kidney failure causes can be categorized into which 3 categories?

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

2

What does GFR measure?

What is the normal GFR and rate of decline?

Standard measurement of
renal function

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

Declines by 1 ml/min/1.73m2 per year

3

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

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

4

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

1) HYPOperfusion

2) Renovascular diseases

5

Name some Pre-renal causes due to Hypoperfusion?

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

6

Name some Pre-renal causes due to Renovascular diseases?

Renal artery stenosis

Renal artery/ vein thrombosis

7

Intra-renal causes of kidney failure?

-Drugs

-Glomerulonephritis

-Acute tubular necrosis/ obstruction

-Metabolic diseases

(infection and allergic rxns)

8

Name some drugs that causes Drug-induced nephrotoxicity?

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

9

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

Direct:
- Aminoglycoside/foascarnet/amphoB
- Adefovir/tenofovir

Indirect:
- Penicillin/rifampicin

10

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

Trigger abnormal immune response

11

Most common cause of End stage renal disease?

Diabetes mellitus nephropathy

12

What is Diabetes mellitus nephropathy associated with?

Other microvascular complications >> retinopathy, neuropathy

13

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

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

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

14

Apart from Diabetes mellitus nephropathy, name other glomerular diseases?

Hypertensive nephrosclerosis
Malignant nephrosclerosis

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

15

What is adult polycystic kidney disease associated with?

Cerebral aneurysm > Intracerebral hemorrhage

16

Compare nephrotic and nephritic syndrome in glomerulonephritis: Renal impairment?

Renal impairment
Nephritis = Usually present
Nephrotic= present or not

17

Compare nephrotic and nephritic syndrome in glomerulonephritis: Proteinuria

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

18

Compare nephrotic and nephritic syndrome in glomerulonephritis: Microscopic
hematuria

Nephritis = ++
Nephrotic= present or not

19

Compare nephrotic and nephritic syndrome in glomerulonephritis: Other associated features

Nephritis = Hypertension
Nephrotic= Edema, hyperlipidemia, Hypoalbuminemia

20

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

Nephritic

21

Is this disease nephiritc or nephrotic: FSGS?

Nephrotic

22

Is this disease nephiritc or nephrotic: Minimal change disease?

Nephrotic

23

Is this disease nephiritc or nephrotic: IgA Nephropathy?

Nephritic

24

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

Nephritic

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

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