renal Flashcards
(61 cards)
nephrotic syndrome following recent EBV infection
-nothing seen on light microscopy of kidney
-electron microscopy shows fusion of podocytes
management?
Minimal change disease
1st= prednisolone
2nd= cylophosphamide
imageing of renal stones?
investigation
1st= non contrast CT KUB
pregnant/ child= US
management of renal stones?
Pain:
1st= NSAID (IM if admitted)
<5mm + asymptomatic
-watch + wait
5mm- 10mmm
-shockwave lithotripsy
Lithotripsy CI pregnancy- retrograde uretroscopy
10mm- 20mm
-shockwave lithotripsy OR nephrolithotomy
Lithotripsy CI pregnancy- retrograde uretroscopy
> 20mm
-nephrolithotomy
diagnosis of AKI?
Rise in creatinine:
>25 ml in 48 hours
OR
>= 50% rise in creatinine over 1 week
OR
< 0.5ml/kg/hour for more than 6 hours in adults
Stage 1 AKI?
Creatinine:
1.5- 1.9 x the baseline
OR
>26 mol rise
UO:
<0.5ml/kg/ hour in 6 hours
management of ureteric stones
Pain
1st= NSAID (IM if admission)
<10mm
alpha blockers + shockwave lithotripsy
10 - 20 mm
-retrograde uretoscopy
1st line imageing- prostate cancer
multi parametric MRI
Stage 2 AKI?
Creatinine:
2.0- 2.9 baseline
UO
<0.5ml/ kg/ hour over 12 hours
Stage 3 AKI?
Creatinine:
>3 x baseline
OR
>353.6
OR
Initiation of renal replacement
OR
Decrease in eGFR <35ml/min
UO
<0.3 ml/ kg/ hour for 24 hours
OR
Anuria
drugs that need stopped in AKI
- NSAIDs (apart from cardioprotective aspirin)
- Aminoglycosides
- ACE inhibitors
- Angiotensin II receptor antagonists
- Diuretics
drugs that may have to be stopped in AKI as increased risk of toxicity (but doesn’t usually worsen AKI itself)
- Metformin
- Lithium
- Digoxin
causes- pre renal AKI
- Insufficient blood supply to kidneys reduces the filtration of blood
- Dehydration- lack of intake, vomiting, diarrhoea, burns
- Pre renal uraemia
- Shock- sepsis, blood loss, anaphylaxis
- Heart failure
- Renal artery stenosis
- NSAIDa/ COX-2
ACEI/ ARBs
investigations AKI
-Creatinine
-U&E
-Urynalisis
-No identifiable cause for deterioration or are at risk of urinary tract obstruction= renal US within 24 hours
Patients at risk of AKI (e.g. on nephrotoxic drugs) requiring investigations with contrast
management
give fluid (reduces risk)
symptoms AKI
Many patients with early AKI may experience no symptoms. However, as renal failure progresses the following may be seen:
-reduced urine output
-pulmonary and peripheral oedema
-arrhythmias (secondary to changes in potassium and acid-base balance)
-features of uraemia (for example, pericarditis or encephalopathy)
causes- hyperkalaemia
-acute kidney injury
-drugs: ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, heparin
-metabolic acidosis
-Addison’s disease
-rhabdomyolysis
-massive blood transfusion
management of mild hyperkalaemia
Mild (5.5 - 5.9 mmol/L)
Monitor potassium levels
Identify and address precipitating factors
Review and discontinue aggravating medications (e.g. ACE inhibitors)
management of moderate hyperkalaemia
Moderate (6.0 - 6.4 mmol/L)
Monitor ECG for changes
Consider IV calcium gluconate if ECG changes present
Administer insulin/dextrose infusion
Consider nebulised salbutamol
Address underlying causes and stop exacerbating drugs
management of severe hyperkalaemia
Severe (≥ 6.5 mmol/L) or ECG changes
Immediate treatment required
IV calcium gluconate to stabilise myocardium
Insulin/dextrose infusion for potassium shift
Nebulised salbutamol as adjunct therapy
Initiate potassium removal strategies (e.g. calcium resonium, loop diuretics, dialysis)
ECG changes hyperkalaemia
peaked or ‘tall-tented’ T waves (occurs first)
loss of P waves
broad QRS complexes
sinusoidal wave pattern
drugs causing AIN?
drugs: the most common cause, particularly antibiotics
-penicillin
-rifampicin
-NSAIDs
-allopurinol
-furosemide
apart from drugs- what are other causes of AIN?
systemic disease: SLE, sarcoidosis, and Sjogren’s syndrome
infection: Hanta virus , staphylococci
histology: marked interstitial oedema and interstitial infiltrate in the connective tissue between renal tubules
+ AKI
what is the cause
AIN
specific features presentation + investigation AIN
some present + think they have had allergic reaction:
-flank pain
-arthalgia
-fever
-rash
-hypertension
urynalisis:
-white cell casts
-sterile pyuria
bloods: esosinophilia
