Flashcards in Renal Deck (24)
What are the different stages of chronic renal failure?
Must have >3 months of abnormal structure or evidence of damage plus:
Stage 1 GFR > 90 (only have CKD if evidence of kidney damage)
Stage 2 GFR 60 - 89 (have CKD even if no other signs)
Stage 3a GFR 45 - 59
Stage 3b GFR 30 - 44 (symptoms usually start)
Stage 4 GFR 15 - 29
Stage 5 GRF <15 (end stage renal failure)
What are the common causes of chronic renal failure?
Hypertension and Diabetes
What are the 7 functions of the kidney?
1. Regulation of H2O and electrolyte balance
2. Excretion of metabolic waste
3. Excretion of bioactive substances that affect body function
4. Regulation of arterial BP
5. Regulation of RBC production
6. Regulation of Vit D production
What are the complications of CKD?
BONE DISEASE - renal osteodystrophy
Phosphate retention very early on, PTH increases and calcium can be high or low.
puritis is common due to build up of nitrogenous waste products
decreased gastric emptying, increased reflux osephagitis, peptic ulcers, acute pancreatitis
gout, insulin resistance, impaired lipid metabolism
Hyperprolactinaemia, increased LH, decreased testosterone, impaired growth in children, abnormal thyroid function
severe uraemia causes decreased cerebral function and decreases seizure threshold
impaired baroreceptor sensitvity, impaired vagal function
16 fold increased of CVD
How should BP be controlled in patients with CKD?
Target BP <130/80 if diabetic
In diabetic kidney disease treat with ACEi even if normal BP
How can urinary tract infections be classified?
Lower tract - urethritis, cystitis or prostatitis
Upper tract - pyelonephritis
uncomplicated - normal renal tract and function
complicated - abnormal renal or GU tract, voiding difficulty or outflow obstruction, decrease in renal function, impaired host defences or virulent organisms
Recurrent UTI = a further infection with a new organism
Relapse = further infection with the same organism
What organisms cause UTIs?
E.coli (most common)
Staph saprophyticus, proteus mirabilis
Enterococcus faecalis, klebsiella, enterobacter, pseudomonas, candida
What are the symptoms of the different types of UTI?
Pyelonephritis: high fever, rigors, vomiting, loin pain and tenderness, oliguria
Cystitis: frequency, dysuria, urgency, strangury, haematuria suprapubic pain
Prostatitis: flu like symptoms, lower back ache, few urinary symptoms, swollen or tender prostate,
What are the causes of sterile pyuria (WBC in urine but no organisms grown on culture)
Inadequately treated UTI
Papillary necrosis (DM or analgesia excess)
What is the triad of nephrotic syndrome?
What are the complications of nephrotic syndrome?
Increased susceptibility to infection - loss of immunoglobulins in the urine
Thromboembolism - hyper-coagulable state
What are the causes of nephrotic syndrome?
Minimal change glomerulonephritis
commonest cause in children
? t lymphocyte mediated
steroids can initiate remission
common in adults
biopsy shows thickened GBM with IgG and C3 subepithelial deposits
treat with steroids if renal function is deteriorating
associated with malignancy, drugs, autoimmune (SLE, RA etc), and infections (HBV, syphilis, leprosy)
Focal segmental glomerulosclerosis
may be primary or secondary (due to vesicouretric reflux, IgA nephropathy, Alports syndrome, vasculitis, sickle cell, heroine)
responds to steroids
>30% develop ESRF
What is the general treatment of nephrotic syndrome?
Monitor renal function
Fluid balance - fluid restrict 1.5l per day
Treat underlying cause
What are the extra renal manifestations of Autosomal dominant polycystic kidney disease?
Intracranial aneurysm - SAH
Mitral valve prolapse
What are the genes responsible for PKD?
ADPKD1 - encodes for the proteins polycystin (a membrane glycoprotein)
Generally have an earlier onset on hypertension
ADPKD2 - encodes for polycystin 2
What is Acute Kidney Injury?
A significant deterioration of renal function over hours or days.
It can be identified by:
Rise in creatinine >26 in 24hrs
50% rise in creatinine over 7days
Fall in urine output to <0.5ml/kg/hr for more than 6hrs
What steps need to be undertaken when a patient is identified as having AKI?
1. The cause needs to be found and corrected
Check and correct fluid status - prerenal
Treat any sepsis
Review medications - stop any nephrotoxic drugs (NSAIDs, Gent, ACEi, Vanc, metformin
Urinalysis - if blood or protein found and no other cause of AKI then ?acute nephritis and refer to the renal team
Renal USS - only offer if likely cause is obstructive or no other cause is found
If any signs of vasculitis (nosebleed, haematuria, increased ESR) do autoantibodies
Insert catheter and monitor hourly fluid balance
Take blood cultures if sepsis
3. Treat complications
Check potassium levels and do ECG to monitor for hyperkalaemia - treat with calcium gluconate and insulin/dextrose if present
Monitor for pulmonary oedema
What are the indications for haemodialysis in AKI?
Intractable pulmonary oedema
What are the causes of AKI?
any thing that will decrease perfusion to the kidney
renal artery stenosis
Reduced cardiac output
obstruction - suggested by anuria
Acute tubular necrosis
What is rhabdomyolysis?
Severe muscle damage resulting in the release of myoglobin, CK, K, PO4
What are the causes of rhabdomyolysis?
Post ischemia - embolism, clamping an artery during surgery
Immbolisation - after fall
Burns, crush injury, excessive exercise, uncontrolled seizures
Drugs - statins, fibrates, alcohol, ectasy, heroine, snake bites, CO, neuroleptic malignant syndrome
Infections - Coxsackie, EBV, influenza
Metabolic - low K and PO4
What is glomerulonephritis?
A group of disorders where there is damage to the glomerular filtrating apparatus causing a leak of protein and blood into the urine.
Patients may be asymptomatic or present with haematuria, proteinuria, renal failure or hypertension.
Give some examples of glomerulonephritides?
commonest in developed world
present with macro or microscopic haematuria
young men who have haematuria after viral infections
biopsy shows- mesangial proliferation, with IgA deposits
Anti-glomerular basement membrane disease
AKA Goodpastures disease
due to developement of antibodies againt type IV collagen
also causes haemoptysis
renal failure may occur very quickly
most common post strep
usually present as a nephritic syndrome
associated with rash on extensor surfaces, polyarthritis, abdominal pain