Renal Flashcards by Catherineh Hunter

nephrotic synd

proteinuria
hypoalbuminaemia
oedema

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nephritic synd

haematuria

HTN

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causes of a nephrotic syndrome

mimimal change disease
focal segmental glomerulosclerosis
membranous glomerulonephritis

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minimal change disease

nephrotic picture

commonest cause in children

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focal segmental glomerulosclerosis

nephrotic picture

commonest cause in adults

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causes of focal segmental glomerulosclerosis

idiopathic
HIV
heroin

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membranous glomerulonephritis

nephrotic picture

2nd commonest cause in adults

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causes of membranous glomerulonephritis

infections
rheumatoid drugs
malignancy

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rule of 1/3 in membranous glomerulonephritis

1/3 resolve
1/3 resolve to cytotoxics
1/3 develop CKD

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causes of a mixed nephritic/nephrotic syndrome

diffuse proliferative glomerulonephritis

membranoproliferative glomerulonephritis

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diffuse proliferative glomerulonephritis

mixed nephritic/nephrotic syndrome

post-strep infection in a child (1-2 w later)

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membranoproliferative glomerulonephritis

mixed nephritic/nephrotic syndrome
type 1: cryoglobulinaemia (hep C)
type 2: partial lipodystrophy

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causes of a nephritic syndrome

rapidly progressive glomerulonephritis

IgA nephropathy

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rapidly progressive glomerulonephritis

nephritic syndrome

aggressive and can cause ESRF in a few days

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causes of rapidly progressive glomerulonephritis

goodpastures syndrome (anti GBM disease)

autoantibodies to type iv collagen
causes pulmonary haemorrhage and rapidly progressive glomerulonephritis

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Mx rapidly progressive glomerulonephritis

aggressive immunosuppression - high dose IV steroids and cyclophosphamide

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where do carbonic anhydrase inhibitors work

the proximal convoluting tubule

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mode of action of carbonic anhydrase inhibitors

facilitate Na/H exchange in the PCT

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example of an osmotic diuretic

mannitol

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where do osmotic diuretics work

PCT and the thin loop of Henle

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mode of action of osmotic diuretics

they stay in the filtrate and inhibit the reabsorption of water to maintain urine output

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examples of loop diuretics

furosemide, bumetanide

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where do loop diuretics work

ascending loop of henle

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mode of action of loop diuretics

block Na/K/Cl triple transporter

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where do thiazide diuretics work

distal convoluting tubule

example of thiazide diuretic

bendroflumethiazide

mode of action of thiazide diuretics

block Na/Cl transporter

where do aldosterone antagonists work

cortical collecting tubule

example of aldosterone antagonist

spironolactone

s/e of spironolactone

hyperkalaemia | gynaecomastia

definition of AKI

1. absolute increase in creatinine by >26.4 micromol/L 2. increase in creatinine by >50% 3. reduction in urine output (<0.5 ml/kg/h)

nephrotoxic drugs

ACEi NSAIDs aminoglycosides (e.g. gentamicin) diuretics

presentation of AKI

``` reduced urine output fluid overload rise in K, urea, creatinine arrhythmias features of uraemia - pericarditis, encephalopathy ```

what is a 'pre-renal' AKI

ischaemia or lack of blood for to the kidneys

pre-renal causes of AKI

hypovolaemia renal artery stenosis hypotension

what is a 'renal' AKI

intrinsic damage to the glomeruli, renal tubules or kidneys themselves

renal causes of AKI

glomerulonephritis acute interstitial nephritis acute tubular necrosis rhabdomyolysis

what is a 'post-renal' AKI

obstruction to the urine coming out of the kidneys

post-renal causes of AKI

kidney stones BPH bladder/cervical/prostate ca

Ix of AKI

urinalysis +/- MSU venous blood gas ECG renal USS

Mx AKI

Fluids!!! stop any nephrotoxic drugs Mx of hyperkalaemia if persistent

mild hyperkalaemia Mx

(5.5 - 6) | calcium resonium - binds to K

moderate hyperkalaemia Mx

(6 6.5) | insulin/dextrose infusion

severe hyperkalaemia Mx

(>6.5) | (any ECG changes) - IV calcium gluconate

IgA nephropathy presentation

- nephritic syndrome young man presenting a couple of days after URTI with episodic macroscopic haematuria

Mx IgA nephropathy

supportive! | steroids shown not to be effective

commonest cause of glomerulonephritis

IgA nephropathy

what is acute interstitial nephritis

renal inflammation localised to the renal interstitium

the main cause of acute interstitial nephritis

DRUGS!!!! - NSAIDs - allopurinol - furosemide - penicillin - rifampicin

presentation of acute interstitial nephritis

``` mild renal impairment fever rash arthralgia eosinophilia HTN ```

Ix acute interstitial nephritis

bloods - U&Es | +/- renal biopsy

Mx acute interstitial nephritis

1. stop offending medicine 2. supportive - fluid and electrolyte balance 3. steroids - if not resolving

causes of acute tubular necrosis

``` renal ischaemia (shock, sepsis) aminoglycosides myoglobin (2 to rhabdo) uric acid (2 to gout) light chain proteins (2 to myeloma) ```

presentation of acute tubular necrosis

features of AKI | "muddy brown casts" in urine

Mx acute tubular necrosis

supportive - fluid and electrolyte balance

Mx rhabdomyolysis

IV fluids +/- urinary alkalinisation (IV sodium bicarb)

main causes of CKD

``` diabetic nephropathy chronic glomerulonephritis chronic pyelonephritis HTN polycystic kidneys ```

stage 1 CKD

normal eGFR > 90 ml/min | signs of kidney damage on other tests

stage 2 CKD

eGFR 60-90 ml/min | signs of kidney damage on other tests

stage 3a CKD

eGFR 45-59 ml/min

stage 3b CKD

eGFR 30-44 ml/min

stage 4 CKD

eGFR 15-29 ml/min

stage 5 CKD

eGFR <15 ml/min | established kidney failure - dialysis or transplant needed

types of dialysis

haemodialysis peritoneal dialysis

haemodialysis

arteriovenous fistula | - takes 6w to mature

peritoneal dialysis

solute is remvoed across the peritoneal membrane Continuous Ambulatory Peritoneal Dialysis (4 bags/day) or Automated Peritoneal Dialysis (1 bag/day)

Mx of CKD

limit disease progression BP reduction - ACEi or ARB Renal bone disease - Alfacaldiol or Phosphate binders CVS - statin Anaemia of Chronic disease - IV iron or erythropoietin injection

presentation of ADPKD

``` HTN recurrent UTIs renal stones haematuria CKD ```

extra-renal manifestations of ADPKD

liver cysts berry aneuryms mitral valve prolaspe cysts in other organs

Ix ADPKD

1. renal US 2. CT abdo/pelvis 3. Genetic testing

Mx ADPKD

symptomatic Tx - complications as they arise

Screening test for relatives of ADPKD

abdo US

presentation autosomal recessive ADPKD

renal masses & renal failure detected on prenatal US ESRF develop in childhood

Renal Flashcards

(73 cards)