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Year 3 - Metabolic Medicine > Nephrology > Flashcards

Nephrology Flashcards

(92 cards)

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1
Q

What is the RAAS system

A

Renin - angiotensin - aldosterone - system

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2
Q

what triggers the RAAS system

A

Blood pressure decreases. Sympathetic nervous system is stimulated (constrictive), MDC’s sense drop in Na+

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3
Q

Describe the RAAS

A

Trigger sets of release of renin from the juxta-glomerular cells
Renin mixes with angiotensinogen to make ACE 1
AC1 mixes with ACE converting enzyme to male ACE 2
ACE 2 acts on adrenal medulla to release aldosterone from the zona glomerulous cells
ACE 2 also increase sympathetic activity and causes constriction of the mouth muscle cells
ACE 2 acts on pituitary and increases ADH secretion = increased H20 reabsorption back into the body meaning less fluid is released as urine

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4
Q

What 3 actions does ACE 2 have on the body?

A
  1. Signal pituitary to release and increase ADHormone, causes increase of fluid reabsopriton back into the body = less urine
  2. Stimulates sympathetic nervous system and restricts blood vessels
  3. Signals adrenal gland to release aldosterone
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5
Q

Where is aldosterone released from?

A

Adrenal cortex (outside of the kidney)

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6
Q

What is the function of aldosterone

A

Acts on the kidneys and colon:
- increase the amount of sodium and chloride reabsorbed into the blood stream (therefore more water)
- increase the amount of potassium excreted into the urine

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7
Q

What are the 3 subgroups of AKI

A

Pre renal
Intra renal
Post renal

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8
Q

What does AKI mean

A

Acute Kidney Injury

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9
Q

What is often associated as the cause of pre renal AKI

A

Heart problems

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10
Q

examples of pre-renal AKI causes (6)

A
  1. Hypovolemia (burns, vomiting, diarrhoea, dehydration)
  2. Extreme blood loss (trauma)
  3. Renal artery stenosis
  4. V-fib = low cardiac output = low perfusion
  5. Cardiogenic shock!
  6. Occlusion
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11
Q

What is often associated with intra-renal AKI

A

Renal injury

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12
Q

What are some causes of intra-renal AKI?

A
  1. Acute Tubular Necrosis
  2. Acute interstitial nephritis
  3. Glomerulonephritis
  4. Rhabdomyolysis
  5. Tumour lysis syndrome
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13
Q

What is often associated with post-renal AKI

A

Ureters, Bladder and urethra

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14
Q

What are common causes of post-renal AKI?

A

Ureter = stones, fibrosis and tumour/mass pressing to occlude

Bladder = transitional zone malignancy, blocked catheter

Urethral = tumour, stones, BPH

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15
Q

What is measured to diagnose AKI

A

Creatinine and urine output

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16
Q

What is classified as stage 1 AKI?

A

Creatinine increased 26 micromol OR 1.5-1.99x baseline

OR

Urine output <0.5 for more than 6 hours

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17
Q

What is classified as stage 2 AKI

A

Creatinine of 2-2.99x baseline

OR

Urine <0.5 for more than 12 hours

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18
Q

What classification indicates stage 3 AKI?

A

Creatinine 3x baseline

OR

Urine output <0.3 for more than 24 hours OR anuria for 12 hours

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19
Q

What is acute tubular necrosis

A
  • Cause of intra-renal AKI
  • ischaemia/death of epithelial cells of the renal tubule
  • indicated by muddy brown casts through a microscope
  • most common cause of intra-renal AKI
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20
Q

What are types of Acute Tubular necrosis

A

Ischaemic and Neprotoxic

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21
Q

What is ischameic acute tubular necrosis

A

Poor blood flow = cell death due to hypoperfusion

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22
Q

What is nephrotoxic ATN

A

Death of epithelial cells of the renal tubules due to drugs such as:
- diuretics
- Aminoglycosides (vancomycin and gentomycin)
- metformin
- NSAIDs
- IV contrast and chemo (cisplatin)

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23
Q

What is AIN

A

Acute interstitial necrosis

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24
Q

What is ATN

A

Acute tubular necrosis

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25
What causes AIN (3 categories)
1. Drugs usually = diuretics(furosemide), antibiotics (penicillin), allopurinol (gout), NSAIDs 2. SLE, Sjorgrens and sarcoidosis (connective tissue disease) 3. Infection
26
What are signs of AIN
White cell casts under microscope Pyuria (puss urine) Triad - fever, rash and eosinophils on FBC
27
What is renal artery stenosis
Cause of pre-renal AKI
28
What are renal stones
Calcifications that form in renal pelvis and travel down the ureters - obstruct the vesicles-uterine junction - can cause post-renal AKI - can cause obstructive pyelonephritis
29
What is the most common form of renal stone
Calcium oxalate
30
What are common renal stones/ (5)
1. Calcium oxalate 2. Calcium phosphate 3. Uric acid stones (due to gout) 4. Cystine stones 5. Xanthine stones 6. Struvite stones = staghorn
31
What renal stones are caused by infection
Struvite
32
What renal stones are caused by gout?
Uric acid stones
33
what renal stones are radio lucent
Uric acid stones and xanthine stones
34
How to treat renal stones in emergency
If infection/emergency situations = treat as emergency and use analgesia (IV diclofenac + paracetamol)
35
How to treat a <5mm renal stone
Watch and wait
36
How to treat a 5-10mm renal stone
Shockwave lithotripsy
37
How to treat a 10-20 mm renal stone
Shockwave lithotripsy + uretoscopy
38
How to treat a >20mm renal stone or Staghorn
Nephrolithotomy - consider URS if PCNL is not an option
39
When is pre-stenting used in shockwave therapy
Staghorn calcifications
40
What is used to diagnose renal stones
Non-contrast CT
41
How to treat pre-renal AKI?
250-500ml fluid and STOP any DAMN dugs
42
What other drugs need to be stopped in AKI
Lithium & Digoxin
43
What can AKI lead to?
Hyperkalaemia
44
How do we treat hyperkalameia
1. IV calcium gluconate 2. Insulin/dextrose infusions to pull potassium into cells out of blood. OR neb salbutamol for same reason 3. Calcium resonium (remove all potassium) 4. Sodium bicarbonate pulls potassium into cells and out of blood 5. Haemodialysis
45
What is defined as chronic kidney disease
Rapid decline in function within 3 months
46
What causes chronic kidney disease?
1. High blood sugars (causes scaring of the kidneys as sugar passes through) = increased creatinine 2. Hypertension (high blood pressure = scarring) 3. Medications/drugs 4. Glomerulonephritis 5. PCKD
47
What is ADPKD
Autosomal Dominant Polycystic kidney disease
48
Signs and symptoms of CKD (6)
- pallor -foamy urine from protein leakage - nausea - pruritis - HTN - peripheral neuropathy
49
What are 3 measurements to diagnose CKD
1. Haematuria 2. eGFR 3. ACR
50
What does ACR measure in CKD
Proteinuria
51
What does eGFR measure in CKD
Creatinine, age and gender - kidney function/filtration power
52
what does haematuria measure in CKD
Infection, malignancy, glomerular nephritis, ADPKD, stones
53
What is key when diagnosing CKD
Need consistent results 3 months apart
54
What is the eGFR classification of stage 1 kidney disease
Stage 1 = >90 eGFR
55
What is the eGFR classification of stage 2 CKD
Stage 2 eGFR 60-89 with some signs of kidney damage ( not just egfr signs need to be there and kidney tests need to be abnormal)
56
what is the eGFR classification for stage 3a kidney disease
Stage 3a = 45-59, moderate reduction in kidney function
57
What eGFR classification is correct for stage 3b CKD
Stage 3b - 30-44 moderate reduction
58
what eGFR classification signifies stage 4 CKD
Stage 4 = 15-29 severe reduction
59
What eGFR classification is stage 5 CKD
<15 = established kidney failure, dialysis or transplant may be needed
60
What ACR classification indicates stage 1 CKD
<3mg
61
What ACR signifies stage 2 CKD
3-30mg
62
What ACR signifies stage 3 CKD
30mg+
63
what should be started if ACR stage 3 CKD
ACE inhibitors or ARB if meeting the criteria and statins also recommended
64
What is accelerated progression
Sustained decline within one year of either 25% or 15ml
65
What zone is prostate cancer primarily developed from
Peripheral zone
66
What are 4 signs of prostate cancer
Urinary changes Incomplete voiding Nocturia ED in some cases
67
What are red flags for prostate cancer
- blood in urine - blood in sperm - weight loss - night sweats - back pain (mets)
68
What can also be caused by prostate cancer
Acute hypercalcaemia due to bone degradation from tumours
69
What are the 4 developments of prostate cancer
Stone (stones) Bone (joint/muscle pain) Groan (loin to groin pain) Psychiatric moan (depression)
70
Can prostate cancer casue back pain?
Yes as can spread to BREAST, BUNGS, BOSTATE, BONE, BIDNEY
71
What criteria is used to assess prostate cancer severity??
Gleason criteria 6 =low grade 7 = middle 9,9,10 = high
72
How to treat localised prostate cancer (T1/2)
1. Conservatively (active monitoring/watch and wait) 2. Radical prostatectomy 3. Radiotherapy
73
How to treat localised advanced prostate cancer (T3/4)
HRT Radical prostatectomy Radiotherapy
74
How to treat metastatic prostate cancer
Anti-androgen therapy (GnRH agonist) Chemo with docetaxel
75
What chemo is used in mets stage prostate cancer
Docetaxel
76
What are the red flags for renal cancer
Hameaturia Loin pain Abdo mass Pyrexia Cannon ball mets Left sided varicocele (bag of worms)
77
What is the most common form of renal cell carcinoma
Clear cell
78
What area does bladder cancer stem from predominantly
Transitional cell
79
What key risk factor contributes towards. Bladder cancer
Smoking
80
What is a main issue of hyperkalaemia
Cardiac arrhythmia risk
81
What is classified as raised potassium
>4.5 really but 5.4 + = mild
82
What is seen on ECG if hyperkalameic
Tall T waves no P waves broad QRS prolonged PR
83
What is Rhabdomyolysis
Break down of muscle cells releasing chemicals into blood
84
4 chemicals that release into the blood
K+, PO4-, myoglobin and CK
85
What chemical from Rhabdomyolysis can cause AKi
Myoglobin
86
5 causes of rhabdomyolysis
1. Crush injuries 2. Strenuous exercises 3. Seizures 4. Statins 5. Prolonged immboility
87
What urine changes occur in rhabdomyolysis
Red/brown
88
What are the main 2 types of glomerulonephritis
Nephrotic and nephritic
89
What is glomerulonephritis
Inflammation of the glomerulous in the kidney
90
What are the 3 signs of nephrotic syndrome
Proteinuria Peripheral oedema Hypercholesterolameia Low serum albumin
91
What are 4 symptoms of nephritic syndrome
1. Hameaturia 2. Oliguria 3. Proteinuria 4. Fluid retention
92
What is the key nephrotic syndrome in children
Minimal change disease

Year 3 - Metabolic Medicine (2 decks)

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