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Ask Doctor Clarke 2018 > Renal > Flashcards

Flashcards in Renal Deck (34)
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1
Q

Definition and detection of AKI

A
  • rise in creatinine from baseline of >50% within 7 days -suspect of oligouria <0.5ml/kg/hr -check creatinine in all ill patients, especially if elderly, or confused -particularly if suspecting sepsis, HF, liver failure, hypotension, dehydration, diabetes -particularly if on nephrotoxic drugs
2
Q

Nephrotoxic drugs

A

stop the DAMN drugs Diuretics ACEi and ARBs Metformin- not nephrotoxic, accumulates + causes lactic acidosis NSAIDs

3
Q

Indications for dialysis in AKI

A

AEIOU Acidosis pH<7.1 Electrolytes e.g. refractory hyperkalaemia Intoxications e.g. salicylate, lithium Overloaded with fluid Uraemia symptoms e.g. encephalopathy

4
Q

Emergency treatment of hyperkalaemia

A

Calcium glauconite to stabilise myocardium- 10ml of 10% slow IV Glucose and insulin IV- 10 units, in 50ml 50% glucose over 15 minutes Salbutamol

5
Q

Causes of CKD

A

HIDDEN hypertension Infection e.g. ureteric reflux in children Diabetes Drugs e.g. analgesic nephropathy, NSAIDs, lithium Exotics e.g. SLE Nephritis, Glomerulonephritis

6
Q

Indications for dialysis in CKD

A

Progressive decline in renal function <15ml/min Symptomatic uraemia despite conservative treatment Volume overload despite fluid restriction and Diuretics Other- pericarditis, Bone Disease, hyperkalaemia despite treatment

7
Q

What is CAPD?

A

Tenckhoff catheter into abdomen Less expensive than haemodialysis More convenient as low tech- holidays Relatively easy to teach May have to stop due to peritonitis Fibrosis may reduce permeability 3 litres of fluid, 4 times a day with 30min exchanges Can cause diaphragm splinting, can’t use in COPD

8
Q

What is removed in CAPD?

A

Urea, creatinine, potassium and phosphate pass along their concentration gradient- isotonic fluid Water is removed down an osmotic gradient, by including some bags of hypertonic fluid with a high glucose and polymer gradient

9
Q

Peritoneal dialysis peritonitis

A

Cloudy effluent- urgent MC&S and culture from ‘first cloudy bag’ Abdominal pain +/- fever Exit site infection (take swab) If I’ll, take blood cultures Gram +ve staph or strep- intraperitoneal vancomycin Gram -ve or pseudomonas- IV ciprofloxacin Uncertain- use both

10
Q

Questions to ask in CKD?

A

What are your energy levels like? Do you get breathless? Do you suffer from itching? (Hyperphosphataemia/ hyperuracaemia) Do you have joint pain/ gout? Do you get numb or tingling feet?

11
Q

Three causes of fatigue in CKD

A

Anaemia- normochromic normocytic Anaemia of chronic disease Solute retention- many retained solutes are cerebral depressants Psychosocial- loss of employment, feeling trapped by chronic disease

12
Q

Three causes of breathlessness in CKD

A

Anaemia, fluid overload, heart failure (CAD and hypertension are common)

13
Q

Peripheral neuropathy in CKD

A

Retention of beta-2-microglobulin leading to amyloidosis of peripheral nerves Underlying diabetes is a common cause of CKD and causes neuropathy

14
Q

Features of CKD

A

BIG BEAN Breathless Itching Gout Bone pain Energy levels low Ankle swelling/ anaemia Neuropathy

15
Q

4 features of renal bone disease

A

Osteoporosis

hyperparathyroidism

osteomalacia

osteosclerosis

16
Q

Features of renal bone disease

A

Often assymptomatic

low back pain/ vertebral crush fracture

brachydactyly (short stubby fingers)

osteolysis of terminal phalanges tuft (acronecrosis)

17
Q

Features of nephrotic Syndrome?

A

Proteinuria >3g per 24hrs, makes urine frothy

hypoalbuminaemia <30g/dl

oedema (loss of protein on optic pressure allows salt and water into extra cellular space; increased salt and water retention by Kidney)

hypercholesterolaemia as Liver makes more cholesterol-linked to compensatory increase in albumin synthesis

Loss of antithrombin 3- increased thrombin activity- hypercoagulable

18
Q

Main cause of nephrotic Syndrome in children

A

Minimal change disease

Idiopathic, steroid responsive

doesnt progress to CKD

19
Q

Main causes of nephrotic Syndrome in adults

A
  • glomerulosclerosis especially due to diabetes
  • membranous Glomerulonephritis- usually idiopathic.
20
Q

Treatment of nephrotic syndrome

A

Oedema- Diuretics and salt retention

minimal change Glomerulonephritis- steroids +/- cyclophosphamide

ACEi reduces protein excretion- lowers glomerular filtration pressure

anticoagulation

statins

21
Q

Features of nephritic syndrome

A

HOST

Hypertension

Oliguria

Smoky Brown haematuria with red cell casts

Trace of oedema

22
Q

Causes of acute nephritis

A

post streptococcal

IgA nephropathy- post strep

vasculitis e.g. SLE

23
Q

Investigations in nephritic symdrome

A

Throat swab, ASO titres, 24hr urinary protein

24
Q

Urea

A

Excreted mainly by kidneys

large renal reserve- rises late in disease

rise with: dehydration, HF, Diuretics, high protein diet, GI bleed, catabolic states (trauma, infection, fever)

low in: liver disease, over hydration

25
Q

Creatinine

A

levels vary depending on muscle mass

low in- elderly

high- young athletes

rise late in renal decline

26
Q

CKD stages

A
27
Q

Blood test acute vs chronic renal failure

A

Normochromic, normocytic anaemia

hypocalcaemia

hyperphosphataemia

28
Q

Prevent renal bone disease

A

Dietary phosphate restriction

phosphate binders

alphacalcidol to correct activated vitamin D deficiency

calcium supplements

29
Q

How do you monitor renal bone disease?

A
30
Q

Causes of hyperkalaemia

A

The hyperkalemia MACHINE

Medications – ACE Inhibitors, NSAIDS, potassium-sparing diuretics

Acidosis – Metabolic and respiratory

Cellular destruction – burns, traumatic injury, hemolysis

Hypoaldosteronism – Addison’s

Intake- excessive

Nephrons- renal failure

Excretion – Impaired

31
Q

How do ACEi cause acute renal failure?

A

pre-renal

efferent Arterial vasodilation, reducing GFR

32
Q

How do NSAIDs cause acute renal failure

A

Prerenal- inhibition of prostaglandin mediated affording arteriole vasodilation

renal- direct nephrotoxic

33
Q

Early complications of ATN

A

hyponatremia

hypokalaemia

hypovolaemia

34
Q

CKD stages

A