Flashcards in Renal Deck (216)
When would renal replacement therapy be indicated in AKI?
increasing hyperkalaemia unresponsive to medical therapy
Pulmonary oedema unresponsive to medical therapy
Severe acidosis pH
What other features tend to present with diabetic nephropathy?
How is glomerular disease mediated?
What 4 things can glomerular disease present as?
1) Nephrotic syndrome
2) Asymptomatic haematuria/proteinuria
3) Nephritic syndrome
4) Rapidly progressive glomerulonephritis
What is IgA nephropathy?
Deposition of IgA in glomerulus causing glomerular disease
What is the likely type of glomerular disease in a child with throat infection, swollen ankles and hypotension?
Post streptococcal glomerular nephritis
A patient with joint pains, rashes and red eyes is likely to have what kind of glomerular disease?
Rapidly progressive glomerular nephritis
Why may a patient with CKD be given statins?
At increased risk of CV problems
How do calcimimetics given to patient with CKD help treat bone disease?
Inhibit parathyroid secretion
Other than hygrogen and bicarbonate reabsorption how else does the kidney buffer the blood?
Conversion of ammonia to ammonium in the urine (extra H+ leaves with it)
What is the normal pH range and when would it be considered dangerously high or low?
What is the Schwartz Barter approach to acid-base diseases based on?
Bonsted lowry definition of acids and bases
Sees hydrogen ion concentration as a function of the ratio between the PCO2 and the serum bicarbonate
What is the Stewart approach to acid base imbalance also termed and what is it based on?
Termed the strong ion difference
Based on the principal that serum bicarbonate does not alter blood pH
How is the anion gap calculated and what is its normal range?
[Na+] - ([HCO3-] + [Cl-])
What does an increase or a decrease in anion gap indicate?
Increase = acidosis
Decrease = alkalosis
What does the MUDPALES acronym stand for in the high anion gap acidosis disease?
Methanol - Drug toxicity
Uraemia - CKD, AKI
Diabetes - ketoacidosis
Paraldehyde - Drug toxicity
Alcohol - drug toxicity
Lactate - Lactic acidosis from liver failure or tissue hypoxia
Ethelyne glycol - drug toxicity
Salicylate (aspirin) - drug toxicity
What is the osmolal gap and in what kind of high anion gap metabollic acidosis would you get an elevated osmolal gap?
In ethylene glycol toxicity
Osmolal gap = difference between serum osmolality and calculated osmolality
Calculated osmolality = 2 x [Na] + glucose + urea
What would calcium oxalate crystals in the urine and an osmolal gap of > 25mOsm/kg indicate?
Ethylene glycol toxicity
What is the treatment for ethylene glycol toxicity?
Alcohol/ Formepizole infusion - inhibit alcohol dehydrogenase (as ethylene glycol is metabollised to glycolate which is toxic to the tissues)
What are the 3 main causes of normal anion gap metabollic acidosis (hyperchloraemic)?
1) GI HCO3- loss
2) Renal HCO3- loss (renal tubular acidosis, atezolamide)
3) Infusion of 0.9% saline
What is the general treatment for acid base disorders in the acutely ill patient?
1) Correct fluid and electrolyte balance
2) Correct underlying cause for acid-base disorder
3) specific therapy to correct HCO3- or PCO2
Where does angiotensin II act on the kidney?
Causes vasoconstriction in the efferent arteriole to increase transglomerular pressure and therefore GFR
What are the 2 main effects of angiotensin II?
2) Release of aldosterone from the adrenal cortex
How do Beta blockers act on the RAAS?
Inhibit the sympathetic tone influence on Renin release
How do renin inhibitors act on the RAAS?
Prevent Conversion of angiotensinogen to angiotensin 1
How do ACEi work on the RAAS?
Prevent the conversion of angiotensin 1 to angiotensin 2 in the lungs
How do ARBs work on the RAAS?
Prevent Ang 2 causing release of aldosterone and vasoconstriction
Ramipril and Lisonopril are examples of what kind of drug?
What are the indications of ACEis and ARBs?