Lecture 13 Flashcards Preview

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Flashcards in Lecture 13 Deck (20):
1

Describe the role of kidneys

Filter blood to remove waste products

Regulate salt and water balance

Regulate acid/base balance

Produce hormones

2

Name the components in an abnormal blood tests

Sodium
Potassium
Urea
Creatinine
Bicarbonate

3

state what is tested in urinalysis

*Blood
*Protein
Glucose
Ketones
Bilirubin
pH
Nitrite
Leucocytes

4

Instead of just measuring the molecular weight protein, what is measured?

Urine protein/creatinine ratio+ albumin/creatinine ratio

Albumin testing becoming the standard assay

5

Describe the invisible haematuria

Bleeding from kidney:
Red cell casts on urine microscopy indicates glomerular disease

Bleeding from lower renal tract:
Anywhere from renal pelvis downwards
Tumours/stones… bladder catheter

6

Describe the urine microscopy

Methodology:
Urine pH
Sample age
Centrifugation
Phase Contrast

Features of bleeding from the glomerulus:
Red cell casts
Dysmorphic red cells

Sample needs to be examined by a trained observer

7

Describe the symptomatic presentations of renal disease

General malaise
Nephrotic syndrome
Nephritic syndrome
Acute Kidney Injury (Acute Renal Failure)
Chronic Kidney Disease

Visible haematuria
Urinary symptoms – frequency, dysuria
Pain

8

Describe the nephrotic syndrome

A triad of:
Proteinuria
Low albumin
Oedema

Associated features:
High cholesterol
Tendency to thrombosis

“Leaky kidneys”
- let through big molecules - albumin

Reduction in colloid osmotic pressure in the blood
- salt and water leaks into tissues

Activation of renin-angiotensin system
- fluid retention

Proteinuria includes Antithrombin III
increased clotting tendency

Increased hepatic protein synthesis
- hyperlipidaemia

9

Describe the clinical features of nephrotic syndrome

Generalised oedema
More than 3g/day of proteinuria
Serum albumin decreased
High cholesterol

10

Describe the definition and epidemiology of acute kidney injury

AKI – a rapid (hours to days) decline in excretory kidney function

AKI – present in 1% of acute hospital admissions and 5% of hospitalised patients develop AKI

Despite advent of dialysis, AKI dialysis mortality has NOT decreased. Today 50% of acute dialysis patients die, mainly from infection and cardiovascular disease. Highest mortality is in multi-organ failure

11

Describe the aetiology of acute kidney injury

Acute Tubular Necrosis e.g. prolonged hypotension such as trauma, sepsis, doctors …
Contrast reactions
Drugs
Rhabdomyolysis
Interstitial Nephritis
Obstruction

12

What are the limitations of the AKIN and RIFLE

Assumes baseline Cr known
Assumes UOP is measured (eg on general wards vs ICUs)
Assumes serum Cr kinetics are similar across different stages of CKD - this may not be so
AKI may be community acquired

13

What are the indications for urgent renal replacement therapy

Uncontrollable fluid overload
Uncontrollable metabolic acidosis
Uncontrollable hyperkalaemia
Uraemic pericarditis / encephalopathy

Poisoning – ethylene glycol, lithium, NSAIDs

14

Describe chronic kidney disease

Redundancy/ reserve
Symptoms non-specific
Itching,
tiredness,
Nausea
Vomiting
Anorexia
Weight loss
Chest pain (uraemic pericarditis)
(Constellation more specific)

Signs: Hypertension, dipstick testing, signs of cause of renal injury

15

What are the irregularities of the chronic kidney disease

‘Uraemic’ symptoms
Nocturia and polyuria
Oedema
Acidaemia/Kussmaul’s
Anaemia
Hypocalcaemia/Hyperphosphatemia

16

What are the differences of acute and chronic kidney disease

Acute
Acidotic, unwell
Usually normal calcium (unless cause)
‘Normal’ size kidneys

Chronic
Surprisingly well
Low calcium / renal osteodystrophy / hyperparathyroidism
Small kidneys on USS
Pigmented

17

Describe ultrasound for kidney disease

Good for:
Renal size
Renal masses or cystic disease
Obstruction
Bladder emptying
No contrast
Cheap

Cons:
Operator dependent
Difficult with obesity

18

Describe the plain X ray for kidney disease

X rays can detect renal calcification or calculi in the kidney, pelvis, line of ureters or bladder
90% renal calculi visible on plain X ray as contain calcium

19

Describe the intravenous urography

Iodine containing contrast injected
Timed serial X rays of the kidneys:
Functional and anatomical information
Much less commonly used now CT available

20

Describe the nuclear medicine for kidney disease

Dynamic studies: isotope is excreted by kidney – DTPA/MAG3

- Best for renal blood flow, obstruction, bladder emptying, GFR

Static studies: isotope is taken up and retained by renal tubular cells – DMSA

- Best for relative renal function, scarring and ectopic renal tissue