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renal conditions Flashcards

(42 cards)

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1
Q

criteria for AKI

A

<48hrs reduction in kidney function -
increase in creatinine >26.4
or increase in creatinine by >50%
or reduction in urine output

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2
Q

cause of prerenal AKI

A 
inadequate blood supply to kidneys reducing filtration of blood
hypovolaemia
dehydration
hypotension
heart failure
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3
Q

causes of prerenal AKI

A 
inadequate blood supply 
hypovolaemia - haemorrhage, burns
renal hypoperfusions - NSAIDs
dehydration - D+V
hypotension (shock)
heart failure
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4
Q

renal causes of AKI

A 
vasculitis
glomerulonephritis
infection
systemic conditions
acute tubular necrosis
gentamicin
rhabdomyloysis
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5
Q

post renal AKI causes

A

obstruction to outflow, back pressure to kidney reducing function
kidney stones
ureter strictures

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6
Q

medication to avoid in patients with AKI

A 
NSAIDs
ACEi/ARB
diuretics
gentamicin
contrast
trimethoprim
potassium sparing diuretic
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7
Q

acute tubular necrosis

A

damage + death to epithelial cells of renal tubules
–> damage occurs due to ischaemia or toxins

commonest cause of AKI

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8
Q

is acute tubular necrosis reversible

A

yes, epithelial cells have the ability to regenerate

takes approx 7-21 days to recover

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9
Q

muddy brown casts on urinalysis

A

acute tubular necrosis

–>renal tubular epithelial cells in urine

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10
Q

complications of acute tubular necrosis

A

hyperkalaemia !!
fluid overload - heart failure, pulmonary oedema
metabolic acidosis pH<7.15

uraemia >40 - can lead to encephalopathy or pericarditis

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11
Q

causes of hyperkalaemia

A

AKI, CKD
rhabdomyolysis
adrenal insufficiency - addisons

spironolactone
ACEi/ARB
NSAIDs

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12
Q

hyperkalaemia ECG

A

tall, tented T waces
flattening or absence of P waves
broad QRS complex

higher it gets progressively bradycardic

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13
Q

effect of hyperkalaemia on muscles

A

muscle weakness - patient complains of jelly legs

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14
Q

immediate management of hyperkalaemia

A

10mls of 10% calcium gluconate (wont lower potassium but will normalise ECG)

insulin with 50mls 50% dextrose
nebulised salbutamol

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15
Q

what would you give a acidotic hyperkalaemic patient

A

sodium bicarbonate (on top of hyperkal tx)

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16
Q

urgent indications for haemodialysis

A

hyperkalaemia - 7/>6.5 unresponsive to treatment
severe acidosis <7.15
fluid overload
urea >40 - pericardialrub/effusion

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17
Q

rhabdomyolysis

Study These Flashcards
A

skeletal muscle tissue breaks down + releases breakdown products into the blood
usually triggered by an event that causes muscle to break down
–> extreme underuse, overuse or traumatic injury

18
Q

presentation of rhabdomyolysis

Study These Flashcards
A 
muscle aches + pain
oedema
fatigue
confusion - elderly frail patients
red brown urine
19
Q

rhabdomyolysis investigation

Study These Flashcards
A

creatine kinase high
myoglobin in urine - gives red-brown colour
hyperkalaemia
–> ECG

20
Q

rhabdomylosis management

Study These Flashcards
A

IV fluids
IV sodium bicarbonate
IV mannitol - increases GFR

21
Q

loss of which hormone in CKD leads to anaemia

Study These Flashcards
A

erythropioetin = hormone that produces RBC

22
Q

management of anaemia of CKD

Study These Flashcards
A 
exogenous eythropoietin
blood transfusion (allosensitisation)
23
Q

Xray changes seen in renal bone disease

Study These Flashcards
A

sclerosis at both ends of vertebrae (denser white)
osteomalacia in centre (less white)

“ruger jersey” appearance (stripes found on rugby top)

24
Q

management of renal bone disease

Study These Flashcards
A

alfacalcidol/calcitriol = active forms of vit D

low phosphate diet
bisphosphonates for osteoporosis

25
diagnosis of polycystic kidney disease
US of kidney + genetic testing --> bilateral cysts
26
genes involved in autosomal dominant PKD
PKD-1 - chromosome 16 (85%) PKD-2 - chromosome 4 (15%)
27
extrarenal manifestations of polycystic kidney disease
cerebral (intracranial) aneurysms hepatic, splenic cysts cardiac valve disease - mitral/aorta regurgitation colonic diverticula aortic root dilatation hernias
28
management of ADPKD
tolvaptain - vasopressin receptor antagonist --> slows development of cysts + progression to renal failure (ESRF mean age = 50yrs) cysts may rupture -> haematuria, resolves
29
classic presentation of autosomal recessive PKD
``` young kids, assoc with hepatic lesions presents in pregnancy as oligohydramnios (low amniotics fluid during pregnancy, fetus not producing enough urine) resp failure at birth underdeveloped ear cartilage low set ears flat nasal bridge ```
30
amyloidosis
deposition of extracellular amyloid (insoluble protein fibrils) in tissues or organs occurs due to abnormal folding of proteins which then aggregate + become insoluble
31
diagnosis of renal amyloidosis
renal biopsy = congo red staining, apple green birefringence under polarised light serum amyloid precursor (SAP) scan (PET scan vibes)
32
types of amyloidosis
AL = production of abnormal immunoglobulin light chains from plasma cells AM = production of acute phase protein (serum amyloid A protein (SAA)) --> assoc with systemic inflammation
33
amyloidosis treatment
AL = immunosuppresion - steriods, stem cell transplant AA = treat underlying condition
34
what are the diffrent types of ANCA + what conditions they indicate?
p-ANCA (MPO) = microscopic polyangiitis + churg-strauss (eosinophilic) c-ANCA(PR3) = granulomatosis with polyangitis (wegners)
35
henoch-schonlein purpura
IgA vasculitis kids purpuric rash on bum + legs post URT 1-3 weeks *IgA nephritis in 50%*
36
granulomatosis with polyangiitis (Wegners)
nose bleeds, crusty nasal secretions, HEARING LOSS, sinusitis haemoptysis cough, wheeze saddle shaped nose rapidly progressing glomerulonephritis
37
types of kiney stones
calcium based - oxalte, phosphate uric acid - no on XRay struvite - bacteria, stag horn cystine - autosomal recessive disease
38
stone responsible for staghorn calculus
struvite recurrent UTIs, bacteria can hydrolyse urea to ammonia
39
kidney stone investigation of choice
CT KUB abdo xray shows calcium
40
pharmacological management of kidney stones
tamsulosin | alpha blocker, aids spontaneous passage
41
key difference between haemodialysis + haemodiafiltration
replacement of extra-convective ultrafiltrate throught the dialysis period in HDF
42
gold standard dialysis vascular access
arteriovenous fistula | artery + vein surgically connected - bypass capillary system, flows high pressure from artery to vein

renal (15 decks)

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