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Flashcards in Nephrology Deck (23)
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1

Classify the different stages of AKI

Stage 1:
• Creatinine ↑ >26umol/dL in 48hrs
• Creatinine ↑ x1.5–2 in 7d
• Urine output <0.5ml/kg/hr 6–12hrs

Stage 2:
• Creatinine ↑ x2–3 in 7d
• Urine output <0.5ml/kg/hr ≥12hrs

Stage 3:
• Creatinine ↑ >3x in 7d
• Urine output <0.3ml/kg/hr in 24hrs
• Anuria for ≥12hrs
• New need for renal replacement

2

What are some sx of severe AKI (3)

Sx of complications:
Uraemia (vom/pruritis/pericarditis/encephalitis)
Hyperkal
Pulm Oedema (fluid overload – unless was pre-renal cause)

3

List some causes of renovascular obstrn in Pre-Renal AKI (3)

Renal aa stenosis ± thrombosis
Embolus
Ao dissection

4

What would the urine osmolality/Na be in:
Early Pre-Renal AKI
Late

Early: High osmolality / Low Na (kidneys can still conc)

Late (ATN): Low osmolality / High Na (lost ability to conc)

5

What are the renal causes of AKI (3)

Acute tubular necrosis (85%)
Interstitial Nephritis (10%)
Glomerular disease (5%)

6

List some causes of ATN (1;3;3)

Prolonged Pre-Renal cause (prolonged poor perfusion)

Drugs:
Aminoglycosides / Cephalos
NSAIDs
Contrast

Toxins:
HUS
Myoglobinuria
Heavy metals

7

What Ix are done into CKD?

Bloods:
FBC/UEs/LFTs/Glucose
Ca/Phos/PTH

Urinary:
Dip + MCS
24hr urinary protein/CrCl

Imaging:
Renal USS (?Obstructive)
CXR (?Pulm Oedema)
DTPA scan (nuclear)
Bone imaging (renal bone diease screen)

Invasive: Renal biopsy

8

Outline the management steps of CKD

1st line: Control BP/DM
ACEis / Statins / Low-dose aspirin

2nd line: Control complications
EPO recombinant / Ca+VitD supps / K restriction

3rd line: Renal replacement therapy (symp CKD5)

9

Describe the effects on Vit D / Ca / PTH in CKD

Vit D ↓ = Ca↓ / Phos↑ = Osteomalacia

Osteomalacia = PTH↑ (2º + 3º long-term)
3º HyperPTH = ↑Ca (Hypercalcaemia)

10

How is renal bone disease treated? (3)

Restrict dietary phosphate
Phosphate binders (CalciChew)
VitD/Ca supps (AdCal)

11

What are the features of renal aa stenosis? (3)

Resistant HTN
Worsening renal func after ACEis (if bilat)
Acute pulm oedema

12

How is renal aa stenosis managed?

Medical:
Aspirin
Statins
Antiplatelets

Surgical:
Angioplasty / stenting

13

List the causes of AKI

Pre-Renal:
Shock
Renovascular obstrn

Renal:
ATN
Interstitial nephritis
Glomerular disease

Post-Renal:
Ureteric obstrn

14

Outline the steps of management for hyperkalaemia (7)

1. ECG
2. Ca gluconate
3. 10Units Actrarapid IV + 50% 50ml glucose
4. Salbutamol neb
5. Ca resonium
6. Bicarb
7. Dialysis

ALSO loop diuretics
STOP Nephrotoxics
TREAT CAUSE

15

List the features of hyperkalaemia (MURDER)

Mm weakness
Urine: oligo/anuria
Resp distress
Decreased cardiac contractility
ECG changes
Reflexes - hypo/areflexia

16

List the DDx causes of hyperkalaemia (MACHINE)

Medications
A
Cellular destrn (haemolysis, tumour lysis, burns, trauma)
Hypoaldosteronism
Intake excess (inc. IV fluids)
Nephrons – renal failure
Excretion impaired

17

What tests should be included when assessing a pt for renal transplant?

Blood Grp
HLA matching
Virology/TB status (immunosupp)

18

What are the complications of renal transplant?

Operative: bleeding/thrombosis/infection /urine leak
Rejection
Ciclo/tacrolimus toxicity
Infection
Malignancy (skin/anal/lymphoma)

19

What are the haematological effects of uraemia?

Platelet dysfunc
Haemolysis
Marrow suppression

20

What are the (2º) causes of glomerulonephritis (NSAID HSP)

Neoplasm
SLE
Amyloid
Infection
Diabetes
HSP

21

What further Ix can be done into UTIs?

USS (hydronephrosis)
CT/IV Urography (exclude structural abns)

22

List some causes of sterile pyuria (5)

Recently treated UTI
Bladder cancer

Appendicitis
TB
Chlamydia

23

What advice can be given for UTIs (5)

Plenty fluids
Frequent voiding (esp post-sex)
Avoid spermicides
Avoid constipation