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Z Year3 Conditions > RENAL > Flashcards

RENAL Flashcards

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1
Q

What is acute kidney injury (AKI)?

A

Syndrome of decreased renal function measured by serum creatinine or urine output, occurring over hours-days

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2
Q

What is creatinine in AKI?

A

> 1.5x baseline within 7 days

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3
Q

What is urine output in AKI?

A

<400ml/day

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4
Q

What is a pre-renal cause of AKI?

A

decreased blood flow to the kidney

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5
Q

What is a post-renal cause of AKI?

A

internal/external obstruction of urine

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6
Q

What are examples of pre-renal causes of AKI?

A
  1. Hypovolemia
    - Haemorrhage Diarrhoea
  2. Renal artery stenosis
    - Acei, ARBs
  3. Hypotension:
    - Sepsis
    - Heart failure
    - Burns
    - Surgery
    - NSAIDs
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7
Q

Why do NSAIDs cause hypotension?

A

decrease in prostaglandins which results in vasodilation

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8
Q

What are internal post-renal causes of AKI?

A
  1. Renal caliculi

2. Urethral stricture

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9
Q

What are external post-renal causes of AKI?

A
  1. Pelvic malignancy

2. BPH

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10
Q

What are the glomerular renal causes of AKI?

A
  1. Glomerulonephritis

2. Haemalytic Uraemic Syndrome (HUS)

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11
Q

What is HUS?

A

triad of microangipathic haemolytic anaemia, thrombocytopaenia and AKI- associated with shiga-toxin producing E.Coli infections- can precipitate AKI because glomeruli become clogged with platelets and damaged RBCs - children

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12
Q

What are the vascular renal causes of AKI?

A

vasculitis e.g. granulomatosis with polyangiitis (Wegners)

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13
Q

When is AKI more common?

A

elderly and co-morbidities eg diabetes

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14
Q

What are the tubular renal causes of AKI?

A
  1. Acute tubular necrosis !!

2. Multiple myeloma

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15
Q

What are causes of acute tubular necrosis?

A
  1. Ischaemic causes eg thromboembolism, nephrotoxic drugs, rhabdomyolysis
  2. Due to pre-renal AKI causes eg hypotension, sepsis
    - Brown parts in urine
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16
Q

What are the interstitial disease renal causes of AKI?

A
  1. Acute interstitial nephritis
    - immune-mediated tubulointerstitial injury
    - due to drug hypersensitivity reaction
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17
Q

How does acute interstitial nephritis present?

A
  1. rash
  2. fever
  3. arthralgia
  4. eosinophiluria
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18
Q

What is the presentation of AKI?

A
  1. malaise
  2. anorexia
  3. vomiting
  4. pruritis
  5. drowsiness
  6. oliguria
  7. coma
    - Cause specific
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19
Q

What is important to ask in AKI history?

A
  1. started nephrotic drugs

2. recent allergic reactions, burns or major surgery

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20
Q

What are the functions of the kidney?

A
  1. maintaing acid-base balance
  2. maintaing water balance
  3. electrolyte balance
  4. toxin removal
  5. blood pressure control
  6. making Erythropoeitin
  7. Vitamin D metabolism
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21
Q

What are complications of AKI?

Study These Flashcards
A
  1. Metabolic acidosis
  2. Hyperkalaemia, hyperphosiamia
  3. Hyper or hypo volemia
  4. Ureamia: increase risk of encaphalopathy and pericarditis
  5. Hypertension
22
Q

What are the investigations for AKI?

Study These Flashcards
A
  1. Bloods: LFTs, FBC, U + Es bicarbonate, blood film
  2. Urinanalysis
  3. ECG
  4. CXR
  5. USS
  6. Renal biopsy
23
Q

What is the management of renal causes of AKI?

Study These Flashcards
A

Refer to specialist: likely biopsy

24
Q

What is the management of pre-renal AKI?

Study These Flashcards
A

manage volume depletion

25
What is the management of post-renal AKI?
Catheter, urological intervention
26
What else do you need to consider with renal management?
1. A: acidosis ABG/VBG= monitor acidosis 2. W: monitoring fluid balance to ensure no fluid overload 3. E: potassium levels/ ECG= ensure no hyperkalaemia, Hyperkalaemic= sign on an ECG? Tented t-waves 4. T: Urea
27
When would you need to consider renal replacement therapy?
1. hyperkalaemia, pulmonary oedema are not being controlled by medical management 2. severe metabolic acidosis, uraemic complications
28
What is the management of hyperkaelaemia?
1. Normal saline 2. calcium gluconate IV (10ml of 10%) - to prevent cardiac arrhythmias 3. 50ml 50% dextrose with 5U actrapid insulin over 15 mins - to drive potassium into cells 3. Then nebulised salbutamol
29
What is the management of metabolic acidosis?
IV sodium bicarbonate
30
What is the management of pulmonary oedema?
1. Oxygen 2. IV diamorphine: relives anxiety and breathlessness 3. IV GTN 4. Frusemide
31
What is the definition of chronic kidney disease (CKD)?
1. Kidney damage (proteinuria/haematuria) 2. OR GFR <60ml/min/1.73m2 - FOR 3 Months
32
What are the stages of CKD?
- risk increases with age | - severity with decreasing eGFR
33
What are the glomerular causes of CKD?
1. Glomerulonephritis 2. DIABETES 3. Amyloidosis 4. SLE
34
What are the vascular causes of CKD?
1. HYPERTENSION 2. Heart failure 3. TTP
35
What are the tubular/interstitial causes of CKD?
1. Interstitial nephritis 2. pyelonephritis 3. medication
36
What are the obstruction causes of CKD?
1. Kidney stones 2. BPH 3. Multiple myeloma
37
What are the medication causes of CKD?
NSAIDs and some antibiotics
38
What are the congenital causes of CKD?
1. PCKD | 2. Alport syndrome
39
What is the presentation of chronic kidney disease?
1. Pruritis 2. Nausea and Vomiting 3. Anorexia 4. Oedema 5. Polyuria (start) /oliguria (end) 6. Shortness of breath (pulmonary oedema) 7. Bruising - Cause specific - Can be asymptomatic as well and aki
40
What are the investigations for CKD?
1. Bloods 2. Urinalysis 3. CXR 4. Renal US 5. Renal biopsy
41
What bloods do you do for CKD?
1. U+ E important for eGFR 2. glucose to check for underlying diabetes 3. Ca, phosphate 4. Autoantibodies
42
What is renal osterodystrophy?
kidneys unable to maintain levels of calcium and phosphate
43
What do you look for un urinalysis for CKD?
1. granular casts (degenerated tubular cells seen in CKD) 2. haematuria 3. proteinuria
44
Why do you do a CXR for CKD?
may detect osteomalacia- sign of renal osteodystrophy which is a complication of CKD
45
What can an US show for CKD?
1. kidney atrophy 2. obstructive causes of CKD 3. asymmetrical small consider renovascular disease
46
How do you investigate eGFR?
serum electrolytes, urea and creatinine
47
What is the definition of glomerulonephritis?
inflammation of the glomeruli leading to nephritic/nephrotic syndrome
48
What are the two main symptoms of glomerularnephritis?
1. proteinuria | 2. haematuria
49
What does IgA nephropathy cause?
nephritic syndrome
50
What are the main symptoms of nephritic syndrome?
1. Haematuria (cococola coloured urine) 2. Oedema 3. Hypertension 4. Oliguria

Z Year3 Conditions (13 decks)

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