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Flashcards in Renal Deck (19):
1

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

2

Causes of renal AKI

A GASH:
Acute tubular necrosis – gentamicin, vancomycin, contrast, metformin, NSAIDs
Glomerulonephritis
Acute interstitial nephritis
Scleroderma
HUS/TTP

3

Causes of post-renal AKI

Intraluminal – calculi, thrombosis, papillary necrosis and sloughing
Intramural – BPH, stricture, tumour
Extramural – pelvic malignancy, retroperitoneal fibrosis

4

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

5

Gold standard for diagnosis of bladder cancer

Cystoscopy

6

Metabolic disturbances in CKD

-Hyperkalaemia
-Hyponatraemia
-Hypocalcaemia
-Hyperphosphataemia
-Metabolic acidosis

7

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

8

Indications for dialysis

HAVE PEE:
-Hyperkalaemia
-Acidosis (metabolic)
-Volume overload
-Elevated urea (>35-50 mM)
-Pericarditis
-Encephalopathy
-Edema (pulmonary)

9

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

10

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

11

Nephrotic syndrome

-Proteinuria >3.5 g/day
-Hypoalbuminaemia
-Hyperlipidaemia
-Oedema
-(Thrombophilia)
-(Lipiduria)

12

Nephritic syndrome

-Haematuria
-Hypertension
-Uraemia
-Proteinuria

13

Prognostic markers in renal cell carcinoma

LDH
Calcium

14

Causes of renal artery stenosis

Atherosclerosis (90%)
Fibromuscular dysplasia (10%)

15

Management of UTI

Tin CAN:
-Trimethoprim
-Cephalexin
-Augmentin
-Nitrofurantoin

16

Composition of renal stones

Calcium oxalate (70%)
Calcium phosphate (15%)
Uric acid (10%) + calcium
Struvite (magnesium ammonium phosphate) (3%)
Cystine (2%)

17

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)

18

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)

19

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