Renal Flashcards
(19 cards)
Causes of pre-renal AKI
HHH:
Hypovolaemia – haemorrhage, dehydration, vomiting, diarrhoea, overdiuresis
Hypotension – heart failure, sepsis
Hindrance of renovascular system – renal artery stenosis, renal vein thrombosis
Causes of renal AKI
A GASH: Acute tubular necrosis – gentamicin, vancomycin, contrast, metformin, NSAIDs Glomerulonephritis Acute interstitial nephritis Scleroderma HUS/TTP
Causes of post-renal AKI
Intraluminal – calculi, thrombosis, papillary necrosis and sloughing
Intramural – BPH, stricture, tumour
Extramural – pelvic malignancy, retroperitoneal fibrosis
Management of BPH
Lifestyle modification:
- Avoid caffeine and alcohol
- Relax when voiding
- Void twice in a row to aid emptying
- Control urgency with distraction methods
Drugs:
- Alpha-blockers (tamsulosin, doxazosin)
- 5a-reductase inhibitors (finasteride)
Surgery:
-TURP
Gold standard for diagnosis of bladder cancer
Cystoscopy
Metabolic disturbances in CKD
- Hyperkalaemia
- Hyponatraemia
- Hypocalcaemia
- Hyperphosphataemia
- Metabolic acidosis
Management of CKD
- Lifestyle modification
- Treat underlying cause
- Treat symptoms and complications – fluid overload, uraemia, metabolic disturbances, anaemia, renal osteodystrophy
- Avoid nephrotoxic drugs
- Slow progression – SNAP, ACEI/ARB, CCB, statin
- Dialysis
- Kidney transplant
Indications for dialysis
HAVE PEE:
- Hyperkalaemia
- Acidosis (metabolic)
- Volume overload
- Elevated urea (>35-50 mM)
- Pericarditis
- Encephalopathy
- Edema (pulmonary)
Haemodialysis
- Machine dialysis using an artificial membrane (dialyser) to filter wastes and remove extra fluid from blood
- Doctor needs to make a site (fistula) where blood can flow in and out of body
- Go to hospital/dialysis centre for 3-5 hr, 3x/week
- Can be home, requiring training - more freedom
Advantages:
- Done by trained health professionals who can watch for problems
- Allows contact with other people on dialysis, for emotional support
Disadvantages:
- Risk of bloodstream infections
- Can cause hypotension and blood clots in fistula
- Feel tired on treatment days
Peritoneal dialysis
- Uses lining of abdominal cavity (peritoneal membrane) and a solution (dialysate) to filter wastes and remove extra fluid from blood
- Requires Tenckhoff catheter – placed in peritoneal cavity and sewn down in pelvis
- 4-6 exchanges every day done at home on your own schedule
Advantages:
- More freedom
- Fewer food/fluid restrictions
- Doesn’t use needles
Disadvantages:
- Risk of peritonitis
- May be hard for some people
Nephrotic syndrome
- Proteinuria >3.5 g/day
- Hypoalbuminaemia
- Hyperlipidaemia
- Oedema
- (Thrombophilia)
- (Lipiduria)
Nephritic syndrome
- Haematuria
- Hypertension
- Uraemia
- Proteinuria
Prognostic markers in renal cell carcinoma
LDH
Calcium
Causes of renal artery stenosis
Atherosclerosis (90%) Fibromuscular dysplasia (10%)
Management of UTI
Tin CAN:
- Trimethoprim
- Cephalexin
- Augmentin
- Nitrofurantoin
Composition of renal stones
Calcium oxalate (70%) Calcium phosphate (15%) Uric acid (10%) + calcium Struvite (magnesium ammonium phosphate) (3%) Cystine (2%)
Management of prostate cancer
- Active surveillance/watchful waiting (with periodic PR, PSA and symptom monitoring)
- Radical prostatecomy (with seminal vesicles and regional lymph nodes)
- Radiotherapy
- Androgen deprivation therapy (by castration, LHRH agonists or anti-androgens)
Gleason grading
1 - small, uniform glands with minimal nuclear change (well-differentiated)
2 - medium-sized acini with more stroma (space) between (moderately-differentiated)
3 - variable-sized glands with some infiltration from margins into surrounding tissues (moderately-differentiated) [most common]
4 - few recognisable glands (markedly atypical) with extensive infiltration into surrounding tissues (poorly-differentiated)
5 - sheets of undifferentiated cells (anaplastic)
Grades of hypertension
Pre-HTN - 120-139; 80-89 Grade 1 (mild) - 140-159; 90-99 Grade 2 (moderate) - 160-179; 100-109 Grade 3 (severe) - ≥180; ≥110
