Flashcards in L79 - Acute and Chronic Kidney failure Deck (61):
Kidney failure causes can be categorized into which 3 categories?
What does GFR measure?
What is the normal GFR and rate of decline?
Standard measurement of
Normal GFR ~ 100-125 ml/min/1.73 m2
Declines by 1 ml/min/1.73m2 per year
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
Give 2 main groups of pre-renal causes of kidney dysfunction?
2) Renovascular diseases
Name some Pre-renal causes due to Hypoperfusion?
– Hypovolemia (GIB/dehydration)
– Septic shock
– Cardiogenic shock
Name some Pre-renal causes due to Renovascular diseases?
Renal artery stenosis
Renal artery/ vein thrombosis
Intra-renal causes of kidney failure?
-Acute tubular necrosis/ obstruction
(infection and allergic rxns)
Name some drugs that causes Drug-induced nephrotoxicity?
Iodine contrast (used in angiograms, sacns...)
Name some antimicrobials that directly cause Drug-induced nephrotoxicity, some with indirect action?
How does – Penicillin/rifampicin cause Drug-induced nephrotoxicity?
Trigger abnormal immune response
Most common cause of End stage renal disease?
Diabetes mellitus nephropathy
What is Diabetes mellitus nephropathy associated with?
Other microvascular complications >> retinopathy, neuropathy
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
Apart from Diabetes mellitus nephropathy, name other glomerular diseases?
Hereditary nephropathies (e.g. Alport's syndrome, Adult polycystic kidney disease)
What is adult polycystic kidney disease associated with?
Cerebral aneurysm > Intracerebral hemorrhage
Compare nephrotic and nephritic syndrome in glomerulonephritis: Renal impairment?
Nephritis = Usually present
Nephrotic= present or not
Compare nephrotic and nephritic syndrome in glomerulonephritis: Proteinuria
Nephritis = ++
Nephrotic= +++ (>3g/DAY LOSS)
Compare nephrotic and nephritic syndrome in glomerulonephritis: Microscopic
Nephritis = ++
Nephrotic= present or not
Compare nephrotic and nephritic syndrome in glomerulonephritis: Other associated features
Nephritis = Hypertension
Nephrotic= Edema, hyperlipidemia, Hypoalbuminemia
Is this disease nephiritc or nephrotic:Anti-GBM disease ?
Is this disease nephiritc or nephrotic: FSGS?
Is this disease nephiritc or nephrotic: Minimal change disease?
Is this disease nephiritc or nephrotic: IgA Nephropathy?
Is this disease nephiritc or nephrotic: Post-infectious GN?
Is this disease nephiritc or nephrotic: Membranous GN?
Is this disease nephiritc or nephrotic: Amyloidosis?
Is this disease nephiritc or nephrotic:Lupus nephritis?
Is this disease nephiritc or nephrotic: ANCA-vasculitis?
Is this disease nephiritc or nephrotic:
Give 4 causes of secondary Glomerulonephritis?
What are the 3 ways to assess renal biopsy?
What is the general treatment for GN?
Angiotensin receptor blocker
Which type of Nephrotic syndrome is only diagnosed with EM histology?
Minimal change disease
Acute/Chronic interstitial nephritis is commonly related to what?
Commonly related to drugs (e.g. rifampicin, allopurinol, NSAIDs, PPI)
What is the interstitial infiltrate of Acute/Chronic interstitial nephritis?
>> usually mononuclear cells with occ. eosinophils)
Name two causes of Acute/Chronic interstitial nephritis other than drugs?
– Infection (e.g. hanta virus,
– Autoimmune disease (e.g. SLE, Sjogren)
Name 4 causes of Intra-renal tubular obstruction?
Light chain cast nephropathy
Rhabdomylosis (myoglobin) (e.g. limb ischemic, crush
Crystallization due to acyclovir (anti-herpes drug)
What is the most common cause of acute kidney injury?
Acute tubular necrosis
Usually due to acute ischemic/toxic event
What are the 3 pahses of acute tubular necrosis?
Initiation (acute drop of GFR; sudden rise in serum urea & Creatinine)
Recovery (polyuric phase)
Recovery of acute tubular necrosis?
Usually recovers within 1-2 wks; can be up to
What is Post renal causes of kidney failure associated with?
Renal impairment is usually associated with BILATERAL obstruction
Which structures can be abnormal and cause post-renal problems?
• Urinary bladder
What is the Most common cause of bilateral hydronephrosis in men?
Benign prostate hyperplasia
Some symptoms of BPH? Due to what?
Hesitancy/ urinary frequency/ weak
Due to growth of prostate blocking flow of urine from bladder to urethra
What test is used to diagnose prostate cancer?
>> measure level of prostate-specific antigen in serum
>> done every year from 40 years old onwards
(+ digital rectal exam)
Lower UTI must result in renal impairment. True or false?
Lower UTI seldom results in
Give 2 causes of urethral problems, which becomes post renal cause of kidney disease?
due to Previous trauma or
What can CA bladder cause?
– Painless gross hematuria
– Can cause bilateral ureteric obstruction
Symptoms of bladder stones?
Name some EXTRAmural ureteric problems?
– Metastatic Lymph nodes
– Post-radiation fibrosis
– Idiopathic retroperitoneal
fibrosis (rare autoimmune)
Name an intramural ureteric problem?
General symptoms of renal failure?
Urinary problems in renal failure?
– Polyuria, nocturia
Cardiovascular problems of renal failure?
– Ankle edema; pulmonary edema
– Hypertension, cardiomegaly
– Uremic pericarditis
Neurological problems of renal failure?
– Restless legs
– Confusion and seizure (uremic encephalopathy)
– Carpel tunnel syndrome (β2-microglobulin amyloidosis)
Hematological problems of renal failure?
– NcNc anemia (Normochromic, normocyticanemia) >> reduced erythropoietin production
– Bleeding tendency >> platelet dysfunction
Endocrine problems of renal failure?
– Infertility, amenorrhea
– Sexual dysfunction
– Growth retardation in children
– Secondary/ tertiary hyperparathyroidism
– Renal osteodystrophy
How is renal osteodystrophy caused?
Phosphate retention is excessive >> loss of Ca2+
Related to secondary or tertirary hyperthyroidism
Electrolyte and acid-base disturbance of renal failure?
– Metabolic acidosis (usually increased Anion Gap)
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