Flashcards in Renal Deck (109):
Which type of fluid should resuscitation be attempted with?
(Hartmann's, Ringer's or plasma-lyte)
With which condition should fluid resuscitation be attempted with colloid?
When is the only situation in which human albumin should be considered in resuscitation?
How much human albumin solution should be given?
100ml every 3L in normal renal function
100ml every 3L if renal dysfunction
What is special about the basal lamina of the Bowman's capsule?
What is CKD ?
Abnormal kidney structure or function persisting for more than 3 months
What is the criteria for stage I CKD?
GFR >90 but structural abnormality or genetic fault
What is the criteria for stage 2 CKD
GFR 60-89, mild reduced kidney function, anatomy and genetic fault
What is the criteria for stage 3 CKD?
3a - GFR 45 - 59
3b - GFR 30 - 44
What is the criteria for stage 4 CKD
What is the criteria for stage 5
GFR <15, renal failure
How long should someone with an AKI be monitored for CKD?
Define accelerated CKD
Sustained decrease in GFR of 25%+ and a change in GFR category within 12 months
What is target BP for CKD?
What is target BP for CKD + diabetes
Symptoms of CKD
Pallor, weight loss, "lemon yellow", uraemic frost, itching, confusion, pericardial rub, Kussmaul breathing, etc
What dietary advice should be given to CKD patients ?
Phosphate, salt, potassium and fluid restriction
What medications can be given in CKD?
Vit D - Alfacalcidol
Phosphate binders - aluminium, calcium or non-calcium based
Abrupt reduction in kidney function in <48hours
Increase in creatinine by 50% or reduction in urine output
Criteria for AKI stage 1
Increase in serum Cr by 26umol or 1.5x
Urine output <0.5mL/kg/hr for 6 hours
Criteria for AKI stage 2
Increase Cr by 2-2.9x
Urine output <0.5mL/kg/hr for 12 hours
Criteria for AKI stage 3
Increase Cr by 3
What are pre-renal causes of AKI?
Hypovolaemia, hypotension or renal hypo perfusion
(Haemorrhage, shock, drugs)
What effect does angiotension II have on GFR
What is the commonest form of AKI?
How is pre-renal AKI treated?
Fluid resus (NOT WITH DEXTROSE), if no improvement with 1L, get help
What are renal causes of AKI
Vascular, glomerular, interstitial nephritis or tubular injury
(Vasculitis, glomerulonephritis, drugs, infection, contrast dyes)
How is renal AKI investigated?
U&Es - high potassium?
FBC and Coag screen - anaemia and abnormal clotting
USS - obstruction and kidney size
Immunology - ANCA, ANA, GBM
When should a renal biopsy be performed?
Rapidly progressive glomerulonephritis, positive immunology and AKI
Only if it is safe to do so
How is a post renal AKI treated?
Relieve the obstruction
At what level is hyperkalaemia considered life threatening?
What should be given in hyperkalaemia?
10mls 10% calcium gluconate
Insulin and salbutamol
When is HD needed in AKI?
Hyperkalaemia, ph<7.15, urea >40
Which "casts" are concerning?
Red cell - nephritic syndrome
Leucocyte - infection or inflammation
Granular - chronic disease
What are the features of nephrotic syndrome?
What are the features of nephritic syndrome?
AKI, oliguria, oedema, hypertension, granular casts
What is glomerulonephritis
Immune-mediated disease affecting the kidneys with secondary tubulointerstitial damage
How do podocytes react to injury?
How does the mesangium react to injury?
Prolierates, releases angiotensin II and
How do endothelial cells react to injury?
How is GN investigated?
Urinalysis - haematuria and proteinuria
Urine microscopy - dysmorphic RBCs, grnaular casts
Biopsy and UPCR
Quantify heavy proteinuria
Quantify Nephrotic syndrome
What are the complications of nephrotic syndrome?
Infection, renal vein thombosis, PE, volume depletion
How can GN be classified?
1 - idiopathic
2 - caused by infection/drugs/disease
What are non-immunosuppressive managements for GN
Anti-hypertensives, ACEi, diuretics, statins
What are immunosuppressive treatments for GN?
Steroids, azothioprine, IV Igs
How is nephrotic syndrome treated
What are the suptypes of idiopathic GN?
Which group is most likely to get minimal change GN?
How is minimal change GN treated?
Steroids - 94% achieve remission
How does FSGS GN affect renal function long term?
50% progress to end stage renal failure after 10 years
What can be 2ndry causes of membranous nephropathy?
Infection, CTD, malignancy, drugs
Which is the commonest GN overall?
What usually precedes IgA nephropathy GN?
resp/GI infection, HSP
How is IgA nephropathy treated?
What treated should be given for Rapidly Progressive GN?
Outline the pathogenesis of diabetic nephropathy
Plasma glucose stimulates growth factors in kidney --> Mesangial expansion --> Diffuse Glomeruloscelrosis
How do diabetics differ in terms of RRT?
Get kidney-pancreas transplant if type 1
Start RRT earlier
Define ischaemic nephropathy
Reduced GFR a/w reduced renal blood flow
Who gets Renal Artery Stenosis?
Older males with artherosclerosis risk factors
How does Renal Artery Stenosis present?
Hypertension, AKI/CKD, flash pul oedema, abdo bruit
How is renal artery stenosis diagnosed?
Imaging - USS, duplex, CT, MR angiography
How is renal artery stenosis treated?
Statins, anti-platelets, stenting
Which mutations are a/w ADPKD
PKD1 gene chromosome 16
PKD2 gene chromosome 4
What are common findings in ADPKD
Massive cysts, enlarged kidneys, benign adenomas
How may ADPKD present
Pain, hypertension, haematuria, light urine
What are extra-renal features of ADPKD
Hepatic cysts that don't affect function
CV valve disease
What will USS show with ADPKD
Bilateral cysts and renal enlargment
How can ADPKD be distinguished from ARPKD in kids?
Hepatic fibrosis suggests recessive disease
How is ADPKD managed?
BP control, hydration, proteinuria reduction
Where are cysts classically in ARPKD?
What is found on examination of ARPKD?
Palpable kidney, hypetension
Describe the morality of ARPKD?
Up to 24% in first year of life
After than 80% live past 15 years
What is the inheritance pattern of Alport's syndrome?
What is Alport's syndrome
Disorder of type IV collagen matrix
Which mutation is a/w Alport's syndrome?
What are features of Alport's syndrome?
Leiomyomatosis of oeso/genetaia
What does renal biospy show on Alport's syndrome?
Variable thickness GBM
How is Alport's treated?
BP control, RRT
What is Anderson-Fabry's disease?
Error of glycophingolipid metabolism causing lysosomal storage disease
How is Anderon-Fabry's disease inherited
What are features of Anderson-Fabry's disease
Dark red/blue angiokeratomas, CV disease, stroke, psychiatric disorders, renal failure
How is Anderson-Fabry's disease treated?
Enzyme replacement - Fabryzyme
How is medullary cystic kidney disease inherited?
How is medullary cystic kidney disease inherited?
What is a medullary spongy kidney?
Dilation of the collecting ducts
How is medullary sponge kidney diagnosed?
Define diffusion in dialysis
The movement of solutes from high to low concentration across a semi-permeable membrane
Which electrolytes build up in ESKD
Urea, K, Na
Define convection in dialysis
Movement of water and its solutes across a semi-permeable membrane in response to a pressure gradient - ULTRAFILTRATION
What is a fistula ?
An artery and vein joined to make an enlarged vessel
What are the cons of a fistula
Requires surgery and maturation of 6-12weeks
What is a tunneled venous catheter?
Catheter in a large vein like internal jugular or femoral
What are the cons of a tunneled venous catheter?
High infection risk, can become blocked, can cause damage to central veins
What are pros of tunneled venous catheter?
Easy to insert
Used right away
What are the pros of a fistula?
Less likely to cause infection
Good blood flow
How is a tunneled venous catheter infection treated?
Vancomycin + Gentamicin
How does PD work?
Solute removal by diffusion across the peritoneal membrane
Water removal by osmosis driven by dialysate fluid glucose
What are the two types of PD?
How many times does CAPD need to be changed per day?
How many times does APD need to be changed per day?
What are complications of PD?
Infection, hernia, anaemia, CV disease
How long does an HD session take
First session 90-120 minutes then build up to 4 hours
What rapid correction of uraemic toxin levels cause?
Disequilirbium syndrome - oodema nad seizures
What are the 6 voiding symptoms?
Poor/intermittent flow, spraying, hesitancy, dribbling, straining