Renal Flashcards
(50 cards)
Which locations do renal stones classically become lodged?
Pelviureteric junction (ureter joins the kidney), Pelvic brim and Vesicourteric junction (where ureter connects to the bladder)
What are the types of renal stones?
Calcium oxalate, phosphate, urate and cystine stones
Sx of renal stones?
Excruciating spasms of loin to groin pain - patients often can not lie still. Nausea and vomiting - infection may also co-exist. Haematuria, proteinuria, sterile pyuria and anuria.
No tenderness on palpation
Dx and TX of renal stones?
Dx = Non-contrast CT KUB
Treat initially with analgesia e.g. diclofenac, give IV fluids.
Remove stones using nifedipine or alpha-blockers e.g. tamulosin. If these do not work use shockwave lithotripsy or basket removal.
How is AKI defined?
Rise in creatinine >26umol/L within 24 hours
Rise in creatinine >1.5x baseline within 7 days
Urine output <0.5mL/Kg/hr for >6 consecutive hours
How do you stage AKI?
Stage 1: Serum Creatinine = 1.5-1.9 x base line OR Urine Output = <0.5ml/Kg/hr for 6-12 hours
Stage 2: SC = 2-2.9 x baseline OR UO = <0.5ml/kg/hr for > 12 hours
Stage 3: SC = >3 x baseline OR UO = <0.3ml/kg/hr for >24 hours or anuria >12 hrs
Pre-renal causes of AKI?
Decreased vascular volume = haemorrhage, D&V, burns, pancreatitis Decreased CO = cardiogenic shock, MI Systemic vasodilation = sepsis, drugs Renal vasoconstriction (afferant arteriole) = NSAIDs/ACEi/ARB
Renal causes of AKI?
Glomerular = glomerulonephritis Interstitial = drug reaction, infection and infiltration e.g. sarcoidosis Vessels = vasculitis, DIC
Post-renal causes of AKI?
Within the renal tract = stone, renal tract malignancy, stricture and clot
Extrinsic compression = pelvic maligancy, BPH/prostate cancer
Tx of AKI?
Pre-renal = IV fluids
Renal = biopsy and reffer to specialist
Post-renal = catheter
Monitor K+, stop nephrotoxic drugs e.g. NSAIDs, ACE-i, ARB
Define CKD?
Abnormal kidney structure or function present for >3 months with implications for health
How do you classify CKD based on GFR?
G1 = GFR >90 ONLY CKD if other evidence of kidney damage e.g. proteinuria/haematuria G2 = GFR 60-89 " G3a = GFR 45-59 Mild-moderate CKD G3b = GFR 30-44 Moderate-severe CKD G4 = GFR 15-29 Severe CKD G5 = GFR <15 Kidney failure
How do you classify CKD based on albumin:creatinine ratio?
A1 = <3 mg/mmol A2 = 3-30 mg/mmol A3 = >30 mg/mmol
What are the commonest cause of CKD?
Diabetes, glomerulonephritis and hypertension/renovascular disease
Sx of CKD?
Peripheral oedema, weight loss, dyspnoea, pruitus, muscle cramps, nausea, fatigue, bone pain and amenorrhoea and impotence
Tx of CKD?
Antihypertensives, statins, diuretics, EPO injections for anaemia, phosphate binders e.g calcium carbonate, vitamin D supplements e.g. colecalciferol.
Dialysis or transplant may be required
What are the 3 types of dialysis?
Haemodialysis = blood is taken from an AV fistula and passed over a semi-permeable membrane against dialysis fluid
Peritoneal dialysis = Catheter is inserted into the peritoneal cavity to allow dialysis over the peritoneum - CAN BE DONE CONTINUOSLY AT HOME
Haemofiltration = Used in critical care when haemodyalsis is not possible due to low blood pressure
Define nephrotic syndrome?
Proteinuria >3g/24hrs, hypoalbuminaemia (<30g/L) and oedema
Causes of nephrotic syndrome?
Primary = Minimal change disease, Focal segmental glomerulosclerosis and Membranous nephropathy Secondary = DM, lupus nephritis, myeloma
Briefly describe the 3 main primary causes of nephrotic syndrome?
Minimal change disease = abnormally functioning podocytes - give prednisolone
Focal segmental glomerulosclerosis = podocyte injury/death - give ACEi and prednisolone
Membranous nephropathy = immune mediated podocyte damage - give ACEi and immunosuppression
Tx of nephrotic syndrome?
Loop diuretics e.g. furosemide, fluid and salt restriction, ACEi/ARB to reduce proteinuria, treat cause (check with renal biopsy)
Define nephritic syndrome?
Inflammation causing massive decrease in eGFR, haematuria, proteinuria (<1g/24hrs), hypertension and oedema.
Briefly describe the causes of nephritic syndrome?
IgA nephropathy = an autoimmune disease where build up of IgA in the kidney leads to inflammatory damage
Post-streptococcal glomerulonephritis = recent throat or skin infection causes streptococcal antigens to deposit in the kidneys
Anti-GBM disease/Goodpastures syndrome = autoantibodies to type 4 collagen cause renal disease and lung disease
What drugs can be used to reduce proteinuria and protect renal function
ACEi or ARB (they inhibit efferent arteriole vasoconstriction so decrease the pressure in the glomerulus)
