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NME > Pre-Renal Disease > Flashcards

Pre-Renal Disease Flashcards

1
Q

Clinical and morphological presentation of renal diseases:

A

insert table

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2
Q

Acute Kidney Injury (AKI):

A
  • occurs when sudden decrease in
    GFR
  • GFR maintained by sufficient blood
    flow to the kidneys and nephron
  • usually reversible
  • GFR dependent on a pressure
    gradient between the incoming
    blood at the afferent capillaries and
    pressure in the Bowman’s space: net
    filtration pressure
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3
Q

AKI: Pre-Renal Disease:

A
  • hypoperfusion: reduced perfusion
    to the kidneys in afferent arteriole
  • occurs whether a patient has
    hypovolaemia, euvolaemia,
    hypervolaemia
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4
Q

5 causes of pre-renal injury:

A
  • intravascular volume depletion:
    absolute hypovolaemia (most
    common)
  • decreased cardiac output
  • renal vasoconstriction
  • renovascular diseases (anatomical)
  • drugs that impair autoregulation
    and GFR in specific setting by
    affecting vascular tone of afferent
    and efferent arterioles
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5
Q

Pre-Renal Injury: Intravascular Volume Depletion- Absolute Hypovolaemia:

A
  • Haemorrhage: trauma, surgical, GI
  • GI losses: diarrhoea, vomiting
  • Renal losses: drug induced/osmotic
    diarrhoea, diabetes
    insipidus, adrenal
    insufficiency
  • Skin/Mucous Membrane: burns,
    hyperthermia
  • Third Space losses: pancreatitis,
    hypoalbuminaemia
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6
Q

Causes of Pre-Renal Injury: Decreased Cardiac Output:

A
  • Diseases of myocardium,
    pericardium, valves, conducting
    system
  • Pulmonary hypertension, PE,
    positive pressure mechanical
    ventilation
  • systemic vasodilatation: sepsis, liver
    failure, anaphylaxis
  • Drugs: antihypertensives,
    anaesthetics, drug overdose
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7
Q

Causes of Pre-Renal Injury: Renal Vasoconstriction (4):

A
  • noradrenaline (sepsis treatment
    when BP drops, too much NA causes
    contraction)
  • liver disease
  • sepsis
  • hypercalcaemia
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8
Q

Causes of Pre-Renal Injury: Renovascular Diseases - Anatomical:

A
  • atheroscleorsis (lipid deposition in
    tunica media spills over into intima
    narrowing blood vessels, rupture
    results in thrombosis and narrowing
    of renal arteries.
  • thromboembolic disease
  • renal artery dissection
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9
Q

Causes of Pre-Renal Injury: Drugs:

A
  • ACE inhibitors
    -     inhibition of prostaglandin
    synthesis by NSAIDs during renal
    hypoperfusion
  • Angiotensin II receptor blockers:
    candesartan
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10
Q

AKI causing Drugs: PCT:

A
  • tubular cell toxicity
  • aminoglycosides
  • amphotericin B
  • cisplatin
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11
Q

AKI Causing Drugs: Interstitial Nephritis:

A
  • NSAIDs
  • Rifampicin
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12
Q

AKI Causing Drugs: Renal Tubules/Blood Vessels:

A
  • acyclovir
  • ampicillin
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13
Q

ACE Inhibitor Therapy Worsening Renal Function:

A

insert
efferent arteriole constricted to maintain pressure for GFR
ACE inhibitor dilates efferent arteriole, reducing intravascular pressure, reduces GFR.

NSAIDs:
constriction of afferent arteriole and therefore reduce GFR

Long term ACE inhibitor protects the small blood vessels from high blood pressure or high intra-glomerular pressure from glomerular sclerosis = renoprotective

only stop in acute situations

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14
Q

Acute Kidney Injury: Renal:

A
  • develops when there is a disruption
    to the anatomy or function of the
    nephron
  • can occur independently or as a
    consequence of pre-renal AKI
  • defined by the area of nephron
    disruption
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15
Q

Acute Kidney Injury: Renal Causes:

A
  • Acute Tubular Necrosis:
    - most common
    - ischaemia/ toxic injury to PCT
  • Acute Interstitial Nephritis:
    - Drug induced: NSAIDs, penicillin
    - Infection: TB
    - Immune-mediated: SLE, sarcoid
  • Glomerular Disease:
    - Nephrotic/Nephritic Syndrome
    - primary: antiglomerular
    basement membrane
    disease
    - secondary: immune complex
    mediated: IgA
    nephropathy
  • Tubular Obstruction:
    - Meyloma
    - Rhabdomyolysis
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16
Q

Acute Kidney Injury: Post-Renal:

A
  • following acute obstruction of
    urinary flow
  • increased intra-tubular pressure
    and reduction in GFR
  • acute urinary tract obstruction leads
    to impaired renal blood flow and
    inflammatory processes
    contributing to diminished GFR
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17
Q

Acute Kidney Injury: Post-Renal Causes:

A
  • Ureter: stones, RFP, ureterocoele
  • Bladder: malignancy
  • Prostate: cancer, BPH
  • Urethra: stricture disease, posterior
    urethral valve
  • Extrinsic compression of ureters:
    pelvic malignancy, lymph nodes
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18
Q

Causes of Acute Kidney Injury:

A

insert

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19
Q

Pre-Renal AKI Symptoms:

A
  • severe dehydration symptoms:
    - sunken eyes
    - dry skin
    - decreases skin elasticity
    - dry mouth and eyes
    - tachycardia
    - dizziness standing or sitting up:
    orthostatic hypotension
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20
Q

AKI: Diagnosis: Pre-Renal:

A

insert slide

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21
Q

Pathophysiology of Pre-Renal AKI:

A

insert

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22
Q

Pre-renal insult and renal injury both result in AKI but pre-renal is

A

reversible
renal is often reversible but can lead to CKD

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23
Q

Distinguishing Pre-renal insult from acute tubular necrosis

A

insert

24
Q

Renal Disease involves

A

parenchymal changes

25
Q

Acute Kidney Injury

A

insert triangle

26
Q

Chronic Kidney Disease occurs how many days after the acute kidney injury

A

> 90 days

27
Q

AKI Staging:

A
  • stage 1: serum creatinine 1.5-1.9x
    reference value
  • stage 2: 2.0-2.9x reference value
  • stage 3: 3.0x reference value
28
Q

Pre-Renal Acute Kidney Injury can lead to acute tubular necrosis.

true or false?

A

true
pre-renal can lead to parenchymal changes seen in renal disease

29
Q

Chronic Kidney Disease:

A
  • kidney waste filtration becomes
    worse over time
  • gradually develops
  • result of chronic illnesses like
    diabetes and hypertension
  • patients often asymptomatic and
    often discovered incidentally
30
Q

Causes of chronic kidney disease:

A
  • diabetes mellitus (type 1& 2)
  • uncontrolled hypertension
  • chronic glomerulonephritis
  • hereditary renal diseases
  • chronic tubulointerstitial nephritis
  • congenital kidney anomalies
  • chronic pyelonephritis
  • renal stones and obstructive
    uropathy
  • chronic infection of kidney: TB
31
Q

Stages of chronic kidney disease

A

insert

32
Q

Staging of CKD:

A

insert

33
Q

Relationship between GFR and Creatinine in early stages of AKI

A
  • reduction in GFR may coexist with
    normal serum creatinine
34
Q

Renal Vascular Disease:

A
  • affects blood flow to and from
    kidneys
  • causes kidney damage, failure and
    high BP
  • manifestation of renal vascular
    disease:
    - Renal Artery Stenosis (RAS)
    - Renal Artery Thrombosis
35
Q

Renal Artery Stenosis:

A
  • manifestation of renal vascular
    disease
  • causes kidney injury and high BP
  • smokers
  • high cholestrol, triglycerides,
    diabetes, obesity, heart disease
    family history
36
Q

Renal Artery Thrombosis:

A
  • manifestation of renal vascular
    disease
  • blood clot in the renal artery
37
Q

AKI Investigations:

A
  • bloods: FBC (high urea, creatinine)
    (anaemia if loss of blood)
    (WBC high if sepsis)
  • serological: U&E, CRP, multiple
    myeloma screen (blood
    and urine)
  • Blood and Urine Cultures
    (bacteraemia)
  • Urine Microscopy
  • urine Dipstick: blood, proteins, WBC

CRP = inflammation

  • immunological tests:
    • ANCA, ANA, dsDNA (serum)
  • Viral serology: Hep B/C, HIV
  • Imaging: CXR, USS Kidney Ureter
    Bladder, Ct KUB
  • Renal Biopsy: intrinsic renal disease

ABG:
- metabolic acidosis: low pH, low
pCO2, low bicarb

38
Q

Management of AKI

A

insert slide

39
Q

Treatment of Pre-renal AKI:

A
  • fluids
  • maintain sufficient BP
  • antibiotics for sepsis
  • renal replacement therapy (RTT):
    - fluid overload
    - hyperkalaemia
    - metabolic acidosis
    - uraemia
40
Q

AKI: Urine Microscopy: Hyaline cast:

A

pre-renal insult

41
Q

AKI: Urine Microscopy: Epithelial Cell Cast:

A

acute tubular necrosis

42
Q

AKI: Urine Microscopy: RBC cast:

A

glomerular diseases

43
Q

AKI: Urine Microscopy: Hyaline cast:

A

pre-renal insult, cast nephropathy in multiple myeloma

44
Q

AKI: Urine Microscopy: WBC cast:

A

tubulointersitial disease/pyelonephritis

45
Q

AKI: Urine Microscopy: Hyaline cast:

A

pre-renal insult, cast nephropathy in multiple myeloma

46
Q

AKI: Urine Microscopy: Hyaline cast:

A

pre-renal insult, cast nephropathy in multiple myeloma

47
Q

AKI: Urine Microscopy: Hyaline cast:

A

pre-renal insult, cast nephropathy in multiple myeloma

48
Q

AKI: Urine Microscopy: Hyaline cast:

A

pre-renal insult, cast nephropathy in multiple myeloma

49
Q

AKI: Urine Microscopy: Hyaline cast:

A

pre-renal insult, cast nephropathy in multiple myeloma

50
Q

AKI: Urine Microscopy: Hyaline cast:

A

pre-renal insult, cast nephropathy in multiple myeloma

51
Q

AKI: Urine Microscopy: Hyaline cast:

A

pre-renal insult, cast nephropathy in multiple myeloma

52
Q

AKI: Urine Microscopy: Hyaline cast:

A

pre-renal insult, cast nephropathy in multiple myeloma

53
Q

AKI: Urine Microscopy: Hyaline cast:

A

pre-renal insult, cast nephropathy in multiple myeloma

54
Q

AKI: Urine Microscopy: Hyaline cast:

A

pre-renal insult, cast nephropathy in multiple myeloma

55
Q

AKI: Urine Microscopy: Hyaline cast:

A

pre-renal insult, cast nephropathy in multiple myeloma

56
Q

AKI: Urine Microscopy: Hyaline cast:

A

pre-renal insult, cast nephropathy in multiple myeloma

57
Q

AKI: Urine Microscopy: Hyaline cast:

A

pre-renal insult, cast nephropathy in multiple myeloma

NME (52 decks)

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