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3B > Renal > Flashcards

Renal Flashcards

1
Q

Kidney functions and measuring renal function

A 
Removal of waste products
Vitamin D activation
Regulate pH
Regulate water
EPO production

Measuring renal function

  • eGFR
  • U&E - Creatinine, creatinine clearance, urea
  • Catheter
  • Calcium
  • Urine dip
  • Albumin:Creatinine ratio - CKD staging
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2
Q

Furosemide

A

Loop diuretic

Works on NKCC2 transporter in ascending limb

OUT:

  • Sodium
  • Potassium
  • Chloride
  • Water

Side effects

  • Postural hypotension
  • HYPOkalaemia
  • HYPOnatraemia
  • HYPOchloraemia
  • HYPOcalcaemia
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3
Q

Bendroflumethiazide

A

Works on DCT
Blocks Na+/Cl- symporter

Side effects

  • Postural hypotension
  • HYPOkalaemia
  • HYPOnatraemia
  • Gout
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4
Q

Spironolactone

A

Aldosterone antagonist
Potassium sparing

DCT and collecting duct
Blocks aldosterone

OUT

  • Sodium
  • Chloride

IN - Potassium

Side effects

  • Postural hypotension
  • HYPERkalaemia
  • Metabolic acidosis
  • AKI
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5
Q

Pre-renal AKI

A

LOW urinary sodium

Hypotension
Dehydration
Haemorrhage

Sepsis
HF
Renal artery stenosis

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6
Q

Renal AKI

A

HIGH urinary sodium
Urine dip = Protein +++

Acute tubular necrosis

  • Most common
  • Due to sepsis

Acute interstitial nephritis - White cells on urine dip
Glomerulonephritis

Sepsis
HUS
Rhabdomyolysis

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7
Q

Post-renal AKI

A

Obstruction

  • Stones
  • Strictures
  • BPH
  • Cancer
  • Surrounding masses
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8
Q

Nephrotoxic drugs

A

Pre-renal

  • NSAIDs
  • ACE-I

Renal

  • Penicillin
  • Cephalosporins
  • Gentamicin

Post-renal - Acetylcholine

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9
Q

AKI risk factors and definition

A 
Age
Dehydration
Nephrotoxic drugs
Contrast
Underlying renal disease 
Diabetes

< 0.5 ml/kg for 6 hours
Creatinine ^ 50% in 7 days

Grading

  1. 1.5-1.9x baseline
  2. 2-2.9x baseline
  3. 3x baseline

eGFR decrease by 25% in 7 days

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10
Q

AKI presentation

A

Asymptomatic

Oliguria
Arrhythmias
Confusion
Seizures
Fluid overload - Oedema

Uraemia

  • Vomiting
  • Dizziness
  • Cognitive impairment
  • Asterixis
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11
Q

AKI investigations and management

A

Urine dip / MC&S
U&E - Urea:Creatinine ratio
Septic screen
USS within 24 hours if cause unknown

Management - Treat cause!

  • IV fluids
  • Stop nephrotoxic drugs
  • Change drugs that are renally excreted - May cause toxicity
  • Treat metabolic acidosis - Sodium bicarbonate
  • Catheter

Treat hyperkalaemia - Calcium gluconate

  • If K > 6.5 or ECG changes
  • Risk of tissue necrosis
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12
Q

HYPERkalaemia aetiology and presentation

A 
Rhabdomyolysis
AKI / CKD
DKA
Addison's
Tumour lysis syndrome

Drugs

  • Spironolactone
  • ACE-I
  • A2RB
  • Heparin

Presentation

  • Weakness
  • Flaccid paralysis
  • Decreased reflexes
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13
Q

HYPERkalaemia investigations and management

A

Investigations

  • U&E
  • ECG - TTT - Tall Tented T waves

Management - C BIG K Drop

  • Calcium gluconate (If ECG changes or K > 6.5)
  • Bicarbonate - Sodium bicarb
  • Insulin
  • Glucose - Dextrose
  • K+ reduction - Salbutamol
  • Dialysis
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14
Q

HYPOkalaemia aetiology and presentation

A

Diarrhoea
Vomiting
Conn’s

DKA treatment - Salbutamol

Drugs

  • Furosemide
  • Thiazides

Presentation

  • Weakness
  • Hypotonia
  • Muscle pain
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15
Q

HYPOkalaemia investigations and management

A

U&E

ECG

  • Inverted T waves
  • ST depression
  • Prolonged PR
  • U waves

Management - KCl - Sando-K

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16
Q

Pyelonephritis

A

E.Coli
Klebsiella
Pseudomonas
Proteus

Presentation

  • Fever
  • Rigors
  • Flank pain
  • N/V
  • Lower UTI symptoms
  • Sepsis

Investigations - Sepsis 6!

  • USS/CT for abnormalities or stones
  • Urine dip / MC&S

Management

  • Abx - Cipro
  • Severe - IV Cef
17
Q

PKD

A

ARPKD - 16,4
ADPKD - 6

Presentation

  • Renal symptoms
  • Abdo mass - Flank
  • Flank pain
  • Recurrent UTIs
  • Haematuria
  • Stones

Associated conditions

  • HTN
  • SAH
  • Mitral valve prolapse
  • Liver cysts

Investigations

  • USS - Multiple cysts on kidneys
  • Screen for SAH

Management

  • Treat HTN
  • Family screening
18
Q

Renal cancer

A

Smoking
Von-Hippel Lindau disease

Clear cell carcinoma - Most common
Transitional cell carcinoma

Presentation

  1. Painless haematuria
  2. Loin pain
  3. Abdo mass
    - Weight loss
    - Left varicocoele - LTV drains into LRV
    - Hepatosplenomegaly
    - Mets - Lung (cannonball mets) / Bone

Investigations

  • Urine dip / MC&S
  • CT + Biopsy
  • CXR - Cannonball mets

Management

  • Partial / Total nephrectomy
  • Chemo/Radio
19
Q

Haematuria aetiology

A

Vascular - Coagulopathy
Iatrogenic - Radiotherapy / Catheter
Trauma - Lacerations
Autoimmune - SLE / RA

Infection

  • LUTI
  • Pyelonephritis
  • TB

Neoplasm

  • Nephroblastoma - Children - Flank mass
  • Renal cell carcinoma - Painless of painful haematuria
  • Bladder cancer - Painless haematuria
  • Prostate cancer / BPH

Drugs - Penicillin / NSAIDs

Other

  • Stones
  • Structural abnormalities
  • Gynae - Endometriosis
  • Renal disease - Glomerulonephritis
20
Q

Haemolytic uraemic syndrome

A

E.Coli O157:H7
“Kid went to a farm”

Presentation

  1. AKI
  2. Thrombocytopenia
  3. Microangiopathic haemolytic anaemia
    - Gastroenteritis

Investigations

  • Urine dip - Haematuria
  • Stool sample
  • AKI work up
  • FBC - Thrombocytopenia + Haemolytic anaemia

Management - Supportive

21
Q

Nephrotic syndrome aetiology and presentation

A

Children - Minimal change disease
FSGS
Membranous nephropathy

Cytokine mediated damage to GBM
^ Glomerular permeability

Presentation

  1. Oedema
  2. Proteinuria
  3. Hypoalbuminaemia
22
Q

Nephrotic syndrome investigations / management / complications

A 
Urine dip - Proteinuria
MSU-MCS
ACR 
FBC
Clotting
Renal biopsy

SLE antibodies

Management

  • Chidren / Steroid sensitive - Prednisolone
  • Adults / Steroid-resistant - Cyclophosphamide

Complications

  • Infections due to loss of IgG
  • Thrombophilia
  • Hypercholesterolaemia
  • AKI
  • HTN
23
Q

Nephritic syndrome

A 
IgA nephropathy
Goodpasture's
Wegener's
PSGN
SLE

Presentation

  • AKI
  • HTN
  • Haematuria

Investigations

  • Urine dip - Haematuria
  • Urinalysis - RBC casts
  • ASO titre
  • ANA
  • ANCA
  • Anti-dsDNA

Management - Supportive

  • Low salt
  • IV Prednisolone
  • Diuretics
24
Q

ACE-I side effects

A

Hyperkalaemia
Renal impairment
Dry cough - Bradykinin
Postural hypotension

25
Q

CKD aetiology

A

Age

DM
PKD
Heart disease

Myeloma
Interstitial disease - TB
Glomerular disease

Smoking
Nephrotoxics - NSAIDs, etc.

26
Q

CKD complications

A

Malaise
Uraemia - Itching
Restless leg syndrome

Amenorrhoea
ED

Anaemia
Electrolyte imbalance

Osteoporosis

27
Q

CKD investigations / findings

A

Bloods

  • Anaemia
  • ESR ^ - Myeloma?
  • Glucose ^ - DM?
  • Hyponatraemia
  • Hyperkalaemia

Urine

  • Proteinuria
  • Haematuria

Other

  • Renal USS
  • CT
28
Q

CKD staging and management

A
  1. > 90
  2. 60-90
    3a. 45-60
    3b. 30-45
  3. 15-30
  4. < 15

Management

  • Control HTN
  • Control DM
  • Prevent CVD
  • Correct anaemia
  • Treat electrolyte imbalance
  • RRT
29
Q

Dialysis indications

A

Dialysis is AA PUMP
(It’s not, but oh well)

Arrhythmias
AKI/CKD

Potassium ^^^^^
Uraemia
Metabolic acidosis
Pulmonary oedema

30
Q

Dialysis types

A

Haemodialysis

  • Blood passed over semi-permeable membrane against dialysis fluid
  • Requires anticoagulation
  • Requires AV fistula
  • Hospital or home treatment
  • Complications - Infection, hypotension, N/V

Peritoneal dialysis

  • Peritoneum used as semi-permeable membrane
  • CI in obesity or intestinal disease
  • Good for young independent patients
  • Complications - Peritonitis, hernia
31
Q

Renal transplant

A

Matching

  • ABO
  • HLA
  • Antibody

Advantages

  • Prolongs life
  • Prevents complications - Anaemia

Risks

  • Operative risk - Infection
  • Cancer risk - Due to immunosuppression
  • Rejection risk
32
Q

Renal transplant rejection types

A

Hyperacute - Minutes Wrong ABO
Accelerated - Days - T-cell mediated
Acute cellular - 3 weeks - Steroids
Chronic - Years - Fibrosis

3B (23 decks)

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