Renal Flashcards by Molly Garner

What is renal colic?

A symptoms caused by kidney stones.

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Where are three common locations for renal stones?

Peli-uteric brim
Pelvic brim
Vesico-uteric brim

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What are the most common contents of kidney stones?

Calcium oxalate 
Calcium phosphate 
Uric acid 
Struvite 
Cystine

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What are the risk factors for kidney stones?

Anatomical abnormalities 
Hypertension 
Gout 
Dehydration 
High calcium intake

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What are the symptoms of kidney stones?

Asymptomatic
Renal colic
UTI symptoms
Haematuria

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What is the presentation of renal colic?

Rapid onset 
Unilateral loin pain 
Radiates to groin/testes/labia 
Nausea 
Vomiting 
Spasmodic/colicky pain

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What are the differential diagnoses for renal colic?

Ruptured AAA
Diverticulitis
Appendicitis
Peritonitis

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What investigations should be carried out in renal stones?

Blood tests - raised calcium/phosphate/urate
Urine dipstick - usually +ve for blood 
MSU 
CT KUB scan - gold standard 
X-Ray/ultrasound

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What is the management for renal colic?

Analgesia

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How do you manage stones of different sizes?

<5mm 90% will pass spontaneously - watchful waiting

>5mm needs action to remove it.

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What are the possible methods of kidney stone removal?

ESWL (shockwave therapy)

Surgery

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What actions can be taken to prevent kidney stones?

Over hydration
Low salt diet
Reduce BMI
Active lifestyle

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What are the possible complications of kidney stones?

Infection
Occlusion of kidney outflow
Chronic renal damage

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What is pyonephrosis?

Infection and obstruction of the kidney.

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What are the risks of pyonephrosis?

Systemic sepsis

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How do you treat pyonephrosis?

IV antibiotics

Drainage

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What are the three possible criteria for diagnosing an AKI?

Rise in creatinine >48micromol/l in 48 hours
Rise in creatinine >1.5x baseline
Urine output <0.5mL/kg/h for >6 hours

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What is creatinine?

A muscle breakdown product that is filtered freely though the glomerulus.

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Why is creatinine a marker for kidney injury?

It is normally removed from the blood by the kidneys - so if it rises then it shows that it is not being removed effectively anymore.

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Why may the creatinine level be misleading?

In a person with low muscle mass the creatinine in their blood is reduced. It will not rise as much as you expect in kidney injury - can be missed.

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What groups of people may have a low creatinine?

Elderly/frail
Amputees
Liver disease

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Is creatinine a 100% accurate of GFR?

No. 15% is secreted into the kidney tubules. So creatinine clearance > GFR.

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What are the risk factors for an AKI?

> 75 years old 
CKD
Cardiac failure 
Diabetes 
Drugs 
Sepsis

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What are the three divisions of the causes of AKI?

Pre-renal
Renal
Post renal

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What are the pre-renal causes of AKI?

Any causes of renal hypoperfusion - hypotension, hypovolaemia, renal artery stenosis.

What are the renal causes of AKI?

``` Acute tubular necrosis Autoimmune Glomerulonephritis Drugs Vasculitis ```

What are the post renal causes of AKI?

Any causes of urinary tract obstruction - stones, malignancy.

What investigations should be carried out in suspected AKI?

``` Urine dipstick (the MSU if indicated) Bloods - U&E, FBC, LFT, clotting, autoantibodies Imaging - ultrasound, CT. ```

What is the presentation of a patient with AKI?

``` Depends on the cause. Nausea Vomiting Dehydration Confusion ```

What is the management of an AKI?

Manage blood volume status - fluids Stop nephrotoxic drugs Treat cause.

What are the possible complications of an AKI?

Hyperkalaemia Pulmonary oedema Uraemia Acidaemia

What are the causes of renal failure?

``` Diabetes Hypertension Glomerulonephritis Obstructive uropathy Congenital causes - polycystic kidney disease. ```

What is chronic kidney disease?

Impaired renal function for > 3 months

At what point in CKD do symptoms usually arise?

Stage 4 (GFR <30)

What are the possible symptoms and signs in CKD?

``` Bilaterally small kidneys Malaise Polyuria/nocturia Fatigue Nausea Vomiting Pruritus ```

What two measures are used to determine the stage of CKD?

GFR | Albuminuria

What is a normal measure of albuminuria?

What is severe increase in albuminuria?

>30

What is a normal GFR?

>90

What is a stage 2 CKD GFR?

60-89

What is a stage 3 CKD GFR?

30-59

What is a stage 4 CKD GFR?

15-29

What is stage 5 CKD GFR?

<15

What health care provision typically manages CKD?

GP up to stage 4 | Nephrologist for end stage

How can you limit the progression of chronic kidney disease?

Tight blood pressure control (ACEi etc) Renal bone disease control Reduce cardiovascular risl (statins/aspirin) Diet modifications - low protein, K+ restriction.

What symptoms may been controlling in CKD?

Anaemia Acidosis Hyperkalaemia Oedema

What treatment is offered in end stage kidney disease?

Renal replacement therapy

At what GFR is renal replacement therapy typically started?

8-10ml/min

What are the two forms of dialysis?

Haemodialysis | Peritoneal dialysis

What is the mechanism of heamodialysis?

Blood is passed over semi-permeable membrane against dialysis fluid in the opposite direction. the toxins in the blood diffuse out.

What are the problems with haemodialysis?

Hypotension Time consuming Blood access problems - infection, thrombosis.

What is the mechanism of peritoneal dialysis?

Peritoneum is used as a semipermeable membrane. Fluid is inserted into peritoneal cavity, toxins diffuse over, fluid is then removed.

What are the problems with peritoneal dialysis?

Peritonitis Exit site infection Loss of membrane function over time.

What is the best form of renal replacement therapy.

Transplant

What are the risks of dialysis?

Cardiovascular risks.

What is possible complications of transplant?

``` Surgical risks - bleeding, infection etc. Delayed graft function Rejection Infection Malignancy Cardiovascular disease ```

What treatment is required post transplant.

Immunosuppression

What are the differences between acute and chronic kidney disease?

Small kidneys v normal Anaemia v no anaemia Diabetes v no diabetes high BP v low BP

What is glomerulonephritis?

Inflammation of the glomerulus

What is the presentation of glomerulonephritis?

Nephrotic syndrome Nephritic syndrome Asymptomatic

What are the physiological effects of glomerulonephritis?

Restricts blood flow --> raised BP Damage to filtration --> protein and blood in urine Loss of filtration capacity --> AKI

What investigation should be carried out in glomerulonephritis?

Bloods - ALL Urine - dipstick, MSU Imaging - ultrasound Biopsy

Name 3 specific types of glomerulonephritis?

IgA nephropathy SLE ANCA associated vasculitis

What is the physiology of nephrotic syndrome?

Inflammation resulting in loss of podocyte extensions.

What is the nephrotic syndrome triad?

Proteinuria (>3.5g/day) - frothy urine Hypoalbuminuria Oedema

What are the primary causes of nephrotic syndrome?

Minimal change disease | Membranous nephropathy

What are the secondary causes of nephrotic syndrome?

Hep B/C | Diabetic nephropathy

What do investigations in nephrotic syndrome show?

Urine dipstick - +++ protein Bloods - low albumin Then biopsy

How do you manage nephrotic syndrome?

Steroids Diuretics ACEi treat cause

What are the complications of nephrotic syndrome?

Infections (loss of Ig in urine) | Thromboembolism

What is the pathophysiology of nephritic syndrome?

Inflammation of the endothelium.

What is the presentation of nephritic syndrome?

Haematuria Proteinuria Hypertension

What do investigation on nephritic syndrome show?

Dipstick - +++ blood | MSU - Red cell casts

What is the most common inheritance of polycystic kidney disease?

Autosomal dominant

What is the gene mutation in polycystic kidney disease?

PKD1 - most common | PKD2

What is the presentation of polycystic kidney disease?

``` Bilateral kidney enlargement Loin pain Haematuria Hypertension Renal colic UTIs and pyelonephritis ```

What are the investigations of polycystic kidney disease?

Ultrasound | Screening should be offered to all first degree relatives

What is the management of polycystic kidney disease?

``` No cure Education Manage hypertension Treat infections Analgesia Dialysis for end stage renal failure. ```

What investigations can be carried out to test fluid status?

``` Blood pressure Jugular venous pressure Pulse pressure Tissue turgor Urine output ```

Renal Flashcards

(79 cards)