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Flashcards in Renal Deck (45):
1

What are some pre renal causes of AKI?

Hypovolaemia
Hypotension (Sepsis, shock, anaphylaxis)
Congestive HF
Liver cirrhosis
Renal hypoperfusion (NSAIDs, ACEi, Renal artery stenosis)

2

What are some intrinsic renal causes of AKI?

ATN due to nephrotoxic agents (e.g. contrast, cisplatin, aminoglycosides)
ATN due to ischaemia
Glomerular Disease
Vasculitis

3

What are some post renal causes of AKI?

Renal stones
Blood clots
Urethral structure
Tumours

4

What are the criteria to diagnose an AKI?

Rise in serum creatine of 26+ umol/L in 48hrs
50% or greater rise in serum creatine in preceding 7 days
A drop in urine output to 0.5ml/kg/hr for 6 hours

5

How would you manage a px with an AKI?

Treat cause (if sepsis, Abx O2 and fluids, if post renal then catheterise)
Stop any nephrotoxic drugs
Catheterise and monitor fluid balance (aim for euvolaemia)
Monitor for complications (eg hyperK+tx with IV calcium gluconate, IV insulin and dextrose, nebulised salbutamol)

6

Oliguria is a urine output less than what?

0.5ml/kg/hour

7

What are some causes of CKD?

Diabetes Mellitus
HTN
SLE, vasculitis
Polycystic kidney disease
Glomerulonephritis
Scarring of kidneys from repeated infections

8

How would CKD kidneys appear on USS?

Shrunken (<9cm)
Hydronephrosis

9

What is the GFR for each stage of kidney disease?

1 >90ml/min
2 60-89ml/min
3a 45-59ml/min
3b 30-44 ml/min
4 15-29ml/min
5 <15ml/min

10

What investigations would you do for suspected CKD?

FBC (anaemia due to less EPO)
U&Es
GFR
Urine dip
HbA1c
Screen for antibodies eg ANCA
USS
Biopsy (only in some cases eg if normal kidneys on scan)

11

Why class of Abx are contraindicated in renal failure?

Aminoglycosides

12

How would you managed a px with CKD?

Optimise BP control
Control any diabetes
Loop diuretics for oedema
If anaemia, optimise iron/ folate/ B12 levels and can give EPO if persistent
Calcium and vitamin D supplements and phosphate binders for osteodystrophy
Monitor CVD risk eg statin and aspirin
Low phosphate and low salt diet, restrict fluid intake
End stage renal failure needs renal replacement

13

CKD is based on decreased kidney function for how long?

At least 3 months

14

Why does hyperphosphataemia occur in CKD and what can this lead to?

Insufficient filtering of phosphate
This can increase PTH secretion, leading to hyperparathyroidism
This can lead to renal bone disease

Can tx by offering a phosphate binder

15

How can metabolic acidosis be treated in CKD?

Oral sodium bicarbonate tablets

16

Why is IV calcium gluconate given in hyperkalaemia?

This is cardioprotective (will not correct high K+, hence other drugs need to be given to do so)

17

What is a differential for AKI, more likely when rise in urea is proportionately bigger than the rise in creatine?

Dehydration

18

How would you manage a px at risk of an AKI who is having a scan that requires contrast?

Temporarily stop drugs eg ACEi, A2RB
Give IV fluids before and after to reduce risk

19

Goodpastures syndrome affects which type of collagen?

Type IV

20

What is a normal anion gap?

8-14 mmol/L

21

How does nephrotic syndrome present (triad)?

Proteinuria (>3.5g/day) causing hypoalbuminaemia and hence oedema

22

What are some causes of nephrotic syndrome?

- diabetic nephropathy
- FSGS
- membranous GN
- minimal change GN
-SLE

23

How much proteinuria is indicative of nephrotic syndrome?

>3.5g/24hr

24

How would you treat nephrotic syndrome?

- loop diuretics
- renal biopsy (to confirm diagnosis, nephrotic syndrome alone is not a diagnosis)
- blood pressure control (ACEi/ A2RB)
- steroids (especially good for minimal change)
- reduce salt in diet

25

What is minimal change glomerulonephritis?

Type of nephrotic syndrome
Common in children
In adults can be idiopathic, paraneoplastic or from drugs eg NSAIDs
Responds to steroids

26

What is focal segmental glomerulosclerosis?

Type of nephrotic syndrome
Can be idiopathic, or due to IgA strep, Alpert syndrome, vasculitis, sickle cell, heroin, HIV
Scarring of glomerular segments

27

What is membranous glomerulonephritis?

Type of nephrotic syndrome
Thickened basement membrane with immune complex deposits
Can be idiopathic or associated with malignancy/ hep B/ drugs e.g. NSAIDs, penicillin, gold/ autoimmune eg SLE

28

What are some complications of nephrotic syndrome?

- increased infection susceptibility because of lost immunoglobulin in urine

- thromboembolism (hypercoagulable state due to loss of natural anticoagulants protein C and S, and increased clotting factors)

- hyperlipidaemia

29

How does nephritic syndrome present?

Haematuria
High BP
Mild proteinuria (not as much as nephrotic syndrome)

30

What are some causes of nephritic syndrome?

IgA nephropathy
SLE
Goodpastures Disease

31

What is IgA nephropathy?

Commonest GN in the world
Type of nephritic syndrome
Often due to post-strep chest infection so increased IgA forms deposits on the cells

32

What is Goodpastures Disease?

Causes type of nephritic syndrome
Auto antibodies to type 4 collagen in the glomerular basement membrane
Can also affect lungs and cause pulmonary haemorrhage (so haemoptysis as well as haematuria)

33

Which type of nephritic syndrome could present with haemoptysis as well as haematuria?

Goodpastures syndrome

34

Which antipsychotic drug can cause polyuria?

Lithium

35

At what GFR should dialysis be started?

<15L/min

36

What drugs are potentially nephrotoxic and should be stopped in AKI?

ACEi
NSAIDs
Aminoglycosides
Diuretics
A2RBs

37

How would you minimise the chance of AKI in a patient requiring contrast?

Ensure they are adequately hydrated with 1L 0.9% saline pre and post op

38

What are some indications for renal replacement therapy?

Uraemia
Acidosis
Hyperkalaemia
Toxins
Fluid overload

39

What variables are need to input into the formula to calculate eGFR?

Age
Sex
Serum creatinine
Ethnicity

40

What are some symptoms of uraemia?

Anorexia
Altered mental state
Pruritis
Weakness
Vomiting
Restless legs
Fatigue
Amenorrhoea
Impotence
Bone pain

41

How will a patients U&Es look if they have severe CKD?

Low Ca
High phosphate
High PTH (secondary hyperparathyroidism)
Raised ALP

42

What type of anaemia can be caused by CKD?

Normochromic normocytic anaemia

43

What are some absolute contraindications to renal transplantation?

Active infection
Cancer
Severe comorbidities/ heart disease
Hyperkalaemia

44

What are some complications of haemodialysis?

Hypotension
Infection/ thrombosis/ stenosis of AV fistula
Time consuming (3x week)

45

What are some complications of peritoneal dialysis?

Peritonitis
Obesity (due to glucose in dialysate)
Hernias
Loss of membrane function over time