Renal Flashcards
(36 cards)
Pyelonephritis
- causative
organisms
- Rx
- KEEP: klebsiella, e.coli, enterococcus, proteus
- Cefotaxime 1g IV BD
name 4 organisms that cause cystitis
- E.Coli (gram neg rods)
- staph. saprophyticus (gram pos cocci)
- proteus
- klebsiella
3 causes of asymptomatic haematuria
- IgA nephropathy
- Thin BM disease
- Alport’s
IgA nephropathy
- features
- Diagnosis
- management
- young male with episodic macroscopic haematuria a few days after URTI
- IgA deposits in mesangium
- steroids
Thin BM disease
- inheritance
- features
- autosomal dominant
- persistent asymptomatic haematuria
Alport’s Syndrome
- inheritance
- clin features
- X-linked dominant
2. microscopic haematuria, renal failure, bilateral SN deafness, retinitis pigmentosa
You’ve got an Alports patient with failing renal transplant, what’s happening?
Caused by anti-GBM antibodies from Goodpasture’s syndrome
Post-streptococcal GN
- common presentation
- diagnosis
- management
- malaise and nephritic syndrome 1-2 weeks after sore throat/skin infection
- raised anti-streptolysin O titre, IgG and C3 deposition
- supportive management
Goodpasture’s disease
- presentation
- management
- haematuria and haemoptysis (GN and pulmonary haemorrhage)
- plasmapheresis & immunosuppression
Membranous GN
- associations
- management
- cancer (lung,colon, breast), autoimmune, HBV infections, drugs (penicillamine, NSAIDs)
- immunosuppression
granulomatosis with polyangiitis
- presentation
- ENT problems (saddle node deformity) with haematuria and conjunctivitis
Features of AD PCKD
presents in adults >40
- abdo mass
- haematuria
- renal stones
- berry aneurysms (SAH)
- HTN
- mitral valve prolapse
definition of CKD
GFF <60 for atleast 3 months with evidence of kidney dysfunction
Aetiology of CKD
- Diabetic nephropathy
- PCKD
- HTN
clinical manifestation of CKD
- fatigue
- pleural effusion
- uraemia: jaundice, pruritis
- peripheral oedema
- hydronephrosis
why does tertiary parathyroidism occur in CKD
in CKD have v low active Vit D so less calcium reabsorption (leading to secondary hyperparathyroidism)
the chronic release of PTH causes hypertrophy so get even HIGHER baseline of PTH with high calcium and phosphate
* basically eventually so much PTH has been released that the calcium levels start to rise DESPITE the CKD*
Conservative management in CKD
Fluid and salt restrict
ACEI
Statins
aspirin
symptomatic management in CKD for:
a) anaemia
b) low calcium- bone problems
a) PO/IV iron- if mild
Darbopoeitin
b) phosphate and calcium binders- calcichew and vit D analogues
- can use Ca supplements- cinacalcet
what tests are important when assessing whether suitable for renal transplant
- virology*
- CMV
- HIV
- TB (via CXR)
- HCV
immunosuppression used in renal transplants
short term- pred
long term- tacrolimus/ciclosporin
what malignancy is commonly linked to immunosuppressed transplant pts
- SCC (most common)
- BCC
- NHL
how does rhabdo present
- management?
- muscle pain, haematuria, AKI 10hrs later
- CK in 1000s
- rehydrate and monitor fluid balance, treat K+, consider sodium bicarb
4 cardinal features of AKI
- Uraemia
- acidosis
- hyperkalaemia
- fluid overload
RIFLE classification
Risk- raised creat x 1.5/ UO <0.5ml/kg/h x6h
Injury- Inc creatinine x2/ UO < 0.5ml/kg/hr x 12 hrs
Failure- inc creatinine x3/ UO <0.3ml/kg/hr x24 (or anuria x24hr)
Loss- persistent ARF >4weeks
ESRD
