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Hayders Phase 2A > renal > Flashcards

renal Flashcards

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1
Q

what are the different types of renal stones

A

Calcium oxalate, 65%
Calcium phoshphate 20%
Uric acid 10%

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2
Q

epidemiology and prevalence of renal stones

A

lifetime risk 10-15% age 20-40 is peak

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3
Q

Risk factors of stone formation

A 
Dehydration - largest risk factor 
pre existing kidney disease 
PCKD 
UTI- Proteus 
Urinary factors - Hypercalcemia 
thiazide= increase uric acid
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4
Q

Prevention of stone formation

A 
Overhydration 
reduce salt and sodium 
normal dairy
moderate protein 
reduce BMI
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5
Q

where can stones form

A

upper, renal pelvis or ureter

lower bladder urethra prostate

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6
Q

Presentation of renal stones

A 
Majority asymptomatic 
renal colic (associated with nausea and vomiting)
Pallor
sweating 
haematuria 
Auria 
UTI symptoms, voiding symptoms 
no signs on examination ( look out for gout tophi as a sign of excess uric acid
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7
Q

what is renal colic

A

severe abd pain, loin to groin
sudden onset
radiates to ipsilateral testicle or labia
writhing pain, unable to find comfortable position
colicky pain
pain usually subsited after a few hours
made worse by exercise or diuretics or alcohol

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8
Q

Investigations and diagnoses of renal stones

A

Before starting investigations start on Analgesia and antiemetics to stabilize patent

Non contrast CT of kidney ureter and bladder NCCT-KUB - diagnostic of stone

identify cause of stone: Bloods, Serum Ca, Serum uric acid. U and E. MC and S of MSU

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9
Q

differential diagnoses for patient present with renal colic

A

AAA
Gynae causes, Torsion of ovaries or ruptured ectopic
MSK
Torsion

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10
Q

Management of renal stones

Include preventative measures

A

Analgesia, NSAIDs, antiemetics
potentially give IV fluid if you want them to pass the stone
watch for sepsis
if stone <1 cm then conservative (hydrain, pain and antiemetic)
stone =2-3cm then lithotripsy (Extracorporeal shock wave lithotripsy)
stone >2cm Ureteroscopic laser

ureteric stent

Prevention of further if hypercalciuria ( thiazide
if hyperuricemia (allopurinol)

trimethoprim or gentamycin

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11
Q

Complication of Renal stones

A

can cause sepsis
obstruction of UT can cause dilation and dilation of the kidney is hydronephrosis. if there was an infection present it could cause pyonephrosis

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12
Q

what is pyonephrosis and presentation

A 
pyelonephritis +hydronephrosis (infection of the kidney)
Loin pain 
fever 
Nausea and vomiting 
haematuria 
proteinuria 
sterile pyuria 
leads to sepsis
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13
Q

treatment of pyonephrosis

A 
Iv antibiotics (gentamicin) + oxygen + drain 
watch for sepsis and potentially transfer to ITU
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14
Q

what does Acute kidney injury mean

A

Spectrum of kidney disease ranging from mild improvement to full kidney failure requiring RRT

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15
Q

What is creatinine and why is it used in

A

its a muscle breakdown product that is filtered freely in the kidney and not reabsorbed so gives indication of kidney filtration levels. elevated serum creatinine suggest reduced filtration

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16
Q

criteria to diagnose AKI

A

> 26 mmol/L rise in serum creatinine
50% increase in serum creatinine
oliguria less than 0.5ml/kg/Hr

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17
Q

what is the time frame for acute kidney injury and chronic kidney injury

A

3 month

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18
Q

risk factors for kidney injury

A 
Diabetes 
liver disease 
sepsis
reduced fluid intake 
age >75 
CKD
Cardiovascular problems 
PMH of urinary symptoms 
urinary symptoms 
Drugs - NSAIDs and ACEi
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19
Q

why can NSAIDs and ACEi have an effect on Kidney

A

Prostaglandins cause afferent dilation which improves GFR
Angiotensin 2 causes efferent constriction whic also improves GFR
having ACEi and NSAIDS blocks this and causes Reduced GFR

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20
Q

causes of AKI

A

commonest are ischemia, sepsis, nephrotoxins
Pre renal - commonest cause (70%)
renal-
Post renal causes- least common

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21
Q

causes of AKI

pre renal

A

hypoperfusion, any reason. HV shock, D and V , sepsis

ACEi or NSAIDs.

renal artery stenosis

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22
Q

causes of AKI

renal

A

acute tubular necrosis (commonest renal cause of AKI)
glomerular cause, autoimmune, SLE, or Glomerulonephritis
interstitial, drugs like aminoglycans
vascular: SLE, ischemic, increased BP

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23
Q

causes of AKI

post renal

A

any obstruction to outflow tract-
lumina, stones, clots
intramural, BPH, Malignancy of bladder, ureter, prostate
extraluminal: compressive malignancy

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24
Q

What can cause Acute tubular nephrosis

A

nephrotoxins,

myoglobinuria by rhabdomyolysis

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25
name some nephrotoxins
aminoglycans, Vancomycin Lithium Methotrexate
26
assessment and investigations of a patient with AKI
assess history: which drugs they are on, Risk factors PMH Urgent Hyperkalemia examination Examination: look for palpable kidney (PCKD) bladder or masses in abdomen , check volume status- BP, JVP, edema, skin turgor. bed tests: Dip stick, looking for nitrates or leukocytes, Microscopy and cultures to look for crystals, cultures blood tests, U and E, FBC, clotting LFT, ESR, CRP, potentially serology Imaging- renal USS, CTKUB,
27
Urgent examination to carry out in AKI
Urgent K+ and ECG checking for Hyperkalemia
28
Investigations and Imagining of AKI
Ultrasound looking for hydronephrosis or obstruction, if hydronephrosis and over 65 suspect BPH and catheterise if not relieved do NCCTKUB to look for stones etc
29
presentation of AKI
Usually asymptomatic and only detected on Blood tests but can present with nausea vomiting, confusion and a wide variety of symptoms (on another flashcard
30
Signs and symptoms of AKI
early: nausea, vomiting, reduced urine output, dizziness, lethargy due to fluid retention, pul odema, nocturnal dyspnea, orthopnea, peripheral oedema due to B, hyper or hypotension , Orthostatic hypotension, tachycardia Confusion haematuria
31
general managment of AKI
``` monitor for hyperkalemia assess fluid volume levels and aim to acheive euvolemia, give fluids or restrict fluids. stop any nephrotoxic drugs, stop NSAIDS, ACEi, Metfroim manage underlying dieseas ```
32
Managment of AKI pre renal renal post renal
Pre renal, if spsis, antibiotics. fluid challange if not CCF Post renal, catheterise, if that doesnt work then NCCT KUB to see if there was stone and clear Renal- may need dialysis or refered to nephrologist
33
WHat are indications for dialysis in AKI
Fluid overload signs and symptoms, JVP, Oedema , Orthopnea, nocturnal Dysnpnoea or Anuria Hyperkalemia metabolic acidosis Uraemic complications like encephalopathy or pericarditis drug overdose
34
Indications to refer AKI to nephrologist
Hyperkalemia
35
what are the complications of uremia
confusion coma pericarditis pericardial rub uremia induced platelet dysfunction, GI bleeds neuropathy, nausea and vomiting, cramps
36
complications of AKI
Hyperkalemia edema uremia acidosis
37
Prevention of AKI
monitoring drugs they are taking, temporarily stopping them if they have D and v ensure patients in hospital are well hydrated use fluid volume charts Med review if D and V
38
ECG changes of hyperkalemia
High T wave absent P wave increased PR interval wide QRS
39
Treatment of Hyperkalemia
IV insulin and Glucose | since insulin stimulates uptake of Glucose
40
what is chronic kidney disease, time to become chronic
Renal impairment for more than 3 Months
41
how is chronic kidney disease staged and what symptoms are found at each stage
EGFR stage 1 > 90 just has risk factors stage 2 = 60-90 proteinuria stage 3 = 30-59 still asymptomatic, N and V stage 4 = 15-30 this is when symptoms usually start to show end stage renal failure <15 - needs RRT at this stage
42
causes of CKD
``` Diabetes M type 2 more than 1 glomerulonephritis (commonest cause)- SLE, Vasculitis, nephropathy Congenital - PCKD Hypertension or renovascular disease Pyelonephritis following from AKI ```
43
Symptoms of CKD
symptoms usually start when there is uremia Anaemia, Pallor lethargy SOB Platelet abnormality - Bruising, epistaxis Skin - pigmentation and pruritus and purpura GI- anorexia, D and V nausea Endo - amenorrhea, erectile dysfunction CNS- confusion, encephalitis CVD, Pericarditis, pericardial rub, hypertension cardiomegally Renal- nocturia, polyuria oedema and pul oedema, dyspnea orthopnea MSK, weakness
44
commonest symptoms of CKD
Uraemic tinge, pigmentation Increased BP Fluid overload signs
45
Investigations and examination of CKD
look for signs of fluid overload and oedema- signs and symptoms, cardiomegaly Bloods: HB, normal or normocytic anemia, ESR and CRP, Ca low , PTH high, PO4- low or High Urinalysis: dipstick, Haematuria, (glomerulonephritis) proteinuria, suggests Glomerular disease. MSand C shows albumin creatinine conc Biochem: creatinine clearance test, estimates GFR and is a screening tool Renal ultrasound for all renal patients, look for hydronephrosis, do biopsy if still unknown
46
Management of CKD conservative
stop nephrotoxic drugs, Limit progress, lower BP Bone disease: use Vit D analouges to lower PTH CVD: statins, Lifestyle and BP Diet, avoid high phosphate food, Potassium restrictions
47
Management of CKD stage 1 to 4
Main cause of death is CVD | so ACEi or ARB plus statins plus diuretics plus CCB if needs be
48
Management of CKD symptoms
anemia, Iron B12 Folate Acidosis, sodium carbonate oedema, diuretics, loop diuretic furosemide prepare for RRT Treat underlying conditions, BPH, Diabetes
49
what is RRT and how to prep for it
Hemodialysis- insert AV fistula Peritoneal dialysis Renal transplant
50
what glomerular nephritis
disease of the glomerulus term for inflammation of glomerulus and nephron can have nephrotic or nephritic presentation
51
Nephrotic syndrome presentation
``` Proteinuria Mild hypertension Mild impairment of GFT Hypoalbuminemia Oedema ```
52
pathophysiology of nephrotic syndrome
Damage to podocytes so protein can leak though causing hypoalbuminemia and oedema . due to reduced albumin in blood liver works more produced more albumin and causes Hyperlipidemia
53
causes of nephrotic syndrome
Primary, Membonous, minimal change, FSGS, focal segmental Glomerulosclerosis Secondary- Diabetes, SLE Amyloid, Hep B or C
54
complication of Nephrotic syndrome
Due to loss of Immunoglobulins- increased risk of infection | due to hyperlipidemia, Increased Risk of Thromboemboli to Mi or Stroke
55
Treatment of Nephrotic syndrome
Oedema, Loop diuretic furosemide Proteinuria: ACEi or ARB Prevent atheromas by statins and anticoagulation Treat underlying cause, usually steroids, glucocorticoids
56
Nephritic syndrome Presentation
Haematuria, Proteinuria, Oliguria | Mod to severe increase in BP and Decrease in GFR
57
nephritic syndrome Pathophysiology
Excess damage to nephron and glomerulus so Blood and protein leak though. reduction in GFR causes oliguria. there is compensatory increase in BP
58
nephritic syndrome causes
Commonest cause is IgA nephropathy (primary cause) other primary cause is mesangiocapillary GN Secondary causes. SLE, ANti GBM disease, Goodpasture's. Post streptococcus infection, Hep b or C vasculitis Drugs, penicillamine
59
Investigations for Glomerulonephritis
Bloods, FBC, U and E, LFT ESR CRP, Serology anti ANA, Anti DsDNA Urinalysis - dip stick and MC and S- look for streptococcus, RBCs, WBCs, albumin Renal Biopsy is gold standard-
60
management of Glomerulonephritis
``` Refer to nephrologist maintain Bp Diuretics for oedema (more in nephrotic) ACEi for proteinuria statins and anticoagulation diet for hyperlipidemia (more in nephrotic) Treat underlying cause potentially steroids or glucocorticoids Potential antibiotic therapy ```
61
nephrotic or nephritic syndromes that need Immunosuppressive therapy (prednisolone)
IgA nephropathy SLE Anti Glomerular basement membrane disease Vasculitis
62
whos is screened for Chronic kidney disease
``` screen at risk patients Diabetes Hypertension CVD BPH Recurrent UTI Family history of ESRD Congenital kidney disease like PCKD ```
63
how is screening for Chronic kidney disease done
Albumin creatinine ratio urinalysis serum creatinine
64
What is polycystic kidney disease
inherited disorder either autosomal recessive or dominant.
65
Prevalence of PCKD and what gene does it affect
PKD1 and 2 on chromosome 16 | 1 in 1000
66
Progression of PCKD
85% progress to ESRD | can cause increased risk of forming renal stones and calculi
67
Signs for PCKD
``` Palpable kidney, Think PCKD Abdominal pain haematuria (from Cyst hemorrhage) Hypertension progressive renal failure SAH UTIs ```
68
pathophysiology of PCKD
cysts in kidney, causing enlargement. they can hemorrhage leads to haematuria cyst infection can cause renal stones Increased risk of renal cell carcinoma
69
extrarenal signs and pathology/complications of PCKD
``` liver cysts intracranial aneurysm- SAH ovarian cyst Diverticular disease Mitral valve prolapse ```
70
complications of PCKD
hypertension, increased cardiovascular morbidity and mortality, chronic renal failure, ruptured intracranial aneurysm, and end-stage renal disease
71
Investigations to confirm this is PCKD
Renal ultrasound | CT or MRI if not found on Ultrasound
72
Investigations to carry out in PCKD to assess damage and other complications
Urinalysis to look for UTI, increased albumin, haematuria. these indicate more likely to progress to severe disease ECG - suspected LV dysfunction Brain CT if suspected SAH Can screen for SAH with MRI angiography
73
Management of PCKD
Monitor kidney function U and E Control BP to 130/90 Treat Infections if painful, Laparoscopic removal of cyst Diet, increase water reduce sodium and avoid caffeine ESRD, Dialysis or transplant Screen relatives and genetic counseling
74
Screening for PCKD
``` Screen in relatives USS less than 40 YO, up to 3 cyst is normal 40-60 year old, Up to 2 cysts per kidney 60 or more up to 4 cysts per kidney ```
75
Who to screen for SAH
1st degree relative with PCKD plus SAH | Screen using MRI angiography

Hayders Phase 2A (10 decks)

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