Renal Flashcards
(21 cards)
What is the definition of AKI?
Serum creatinine increase by > 25 micro mol/litre in 48 hours
Serum creatinine increase by >50% over 7 days
Urine output decrease to 0.5 mls/kg/ hour over 6 hours
Renal causes of AKI
Glomerulonephritis Acute tubular necrosis Acute interstitial nephrosis Rhabdomyolysis Tumour lysis syndrome
Pre-renal causes of AKI
Hypovolaemia
Renal artery stenosis
Post renal causes of AKI
Kidney stone BPH External compression of the ureter Cancers Strictures
Causes of CKD
Diabetes Hypertension Age related decline Glomerulonephritis Polycystic kidney disease NSAIDs Chronic use of PPIs Lithium
Causes of hyperchloraemic metabolic acidosis (normal anion gap)
gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula renal tubular acidosis drugs: e.g. acetazolamide ammonium chloride injection Addison's disease
Causes of metabolic acidosis with a reduced anion gap
Lactate: shock, sepsis, hypoxia
Ketones: diabetic ketoacidosis, alcohol
Urate: renal failure
Acid poisoning: salicylates, methanol
Causes of lactic acidosis type A
Sepsis, shock, hypoxia, burns
Causes of lactic acidosis type B
Metformin
Gold standard test for reflux nephropathy
Micturating cystography
How much potassium should you give in maintenance fluids?
1 mmol/kg/day
What are the differences between IgA nephropathy and post strep glomerulonephritis?
Post-streptococcal glomerulonephritis is associated with low complement levels
The main symptom in post-streptococcal glomerulonephritis is proteinuria (although haematuria can occur)
There is typically an interval between URTI and the onset of renal problems in post-streptococcal glomerulonephritis
Conditions associated with IgA nephropathy
Alcoholic cirrhosis
Coeliac disease/dermatitis herpetiformis
Henoch-Schonlein purpura
Classic presentation of IgA nephropathy
young male, recurrent episodes of macroscopic haematuria
typically associated with a recent respiratory tract infection
nephrotic range proteinuria is rare
renal failure is unusual and seen in a minority of patients
How do you calculate the anion gap?
(Na+ + K+) - (Cl- + HCO-3)
Mineral bone disease in CKD pathogenesis
1-alpha hydroxylation normally occurs in the kidneys → CKD leads to low vitamin D
The kidneys normally excrete phosphate → CKD leads to high phosphate
Management of hyperkalaemia
Administer calcium gluconate 10% 10-20ml by slow IV injection titrated to ECG response
Give 10 U Actrapid in 50 ml of 50% glucose over 10-15 minutes
Consider use of nebulised salbutamol
Consider correcting acidosis with sodium bicarbonate infusion
When should you treat hyperkalaemia?
If K+ > 6.5 mmol/l or if there are ECG changes
Ultrasound findings of a patient with diabetic nephropathy
large/normal sized kidneys
Typical immunosuppression therapy post renal transplant
Tacrolimus
Mycophenolate
Prednisolone
Complications of long term steroid use
Ischaemic heart disease
Type 2 diabetes (steroids)
Infections are more likely and more severe
Unusual infections can occur (PCP, CMV, PJP and TB)
Non-Hodgkin lymphoma
Skin cancer (particularly squamous cell carcinoma)
