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Renal Disease Flashcards

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1
Q

Nephrotic Triad

A

Proteinuria, oedema, hypoalbuminemia

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2
Q

Why hypercholesterolemia in nephrotic

A

Hypoalbuminemia -> increased liver production -> secondary effect

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3
Q

Nephrotic at increased risk of

A

Thrombosis

Sepsis

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4
Q

Why thrombosis risk

A

Pee out antithrombin III

Increased fibrinogen production

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5
Q

What is nephrotic syndrome

A

Damage to the podocytes

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6
Q

What are podocytes

A

Third layer of filtration+contain a negative charge to

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7
Q

What is minimal change

A

Loss of foot processes of podocytes

Associated with Hodgkin’s lymphoma, asthma and eczema

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8
Q

Why is it called minimal change

A

Cannot see abnormality on light microscopy

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9
Q

What is membranous

A

Thickened basement membrane - spike/dome appearance

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10
Q

Types of nephrotic (5)

A 
Minimal change
Membranous
Focal segmental
Membranoproliferative
Lupus associated
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11
Q

Most common nephrotic

A

FSGS

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12
Q

What is FSGS

A

Parts of some glomeruli are scarred

IgM associated

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13
Q

Prognosis for membranous

A

1/3 recover, 1/3 relapse, 1/3 end stage

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14
Q

What is mesangiocapillary also known as

A

Membranoproliferative

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15
Q

What is mesangiocapillary?

A

Increase number of cells in glomerulus and alterations in the basement membrane. The deposits in the glomerular mesangium and basement membrane cause complement activation

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16
Q

What nephropathy is hepC associated with

A

Mesangiocapillary

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17
Q

What type of nephropathy can lupus cause

A

All of them

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18
Q

What is nephritic syndrome

A

Haematuria, hypertension, oedema, oliguria

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19
Q

Why do nephritics have oedema

A

Fluid retention

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20
Q

Types of nephritic

A

IgA, post infectious, mesangiocapillary, rapidly progressive

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21
Q

Types of mesangiocapillary GN

A

Type 1 - circulating immune complexes - SLE, Hep B+C

Type 2 - dense deposit disease - excessive activation of the complement system

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22
Q

Types of rapidly progressive GN

A

Type 1 - goodpasture
Type 2 - immune complex mediated e.g. SLE
Type 3 - GPA and eGPA

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23
Q

What is GPA

A

Granulomatosis with polyangitis

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24
Q

What is eGPA

A

eosinophilic granulomatosis with polyangitis

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25
Who is eGPA common in
Asthmatics
26
What is IgA
IgA deposits in the space between glomerular capillaries
27
Most common nephritic
IgA
28
What is Henoch-Schonlein purpora
Systemic form of IgA nephropathy, common in children, small bruises affecting the buttocks and lower legs
29
How long post infection for streptococcal
2 weeks
30
How long post infection for IgA
24-48 hours, particularly respiratory infections
31
What is good pastures
anti-GBM disease - antibodies attach the basement membrane in the lungs and kidneys
32
Basement membrane is
Type 4 collagen
33
How to assess renal plasma flow
Para-aminohippurate clearance (PAH)
34
What HLA antigen is most important in renal transplant
DR > B > A
35
What most likely to die from on dialysis?
Ischaemic heart disease
36
Post op problems with renal transplant?
``` Acute tubular necrosis Vascular thrombosis Urine leakage UTI Rejection ```
37
What is hyper acute vs acute vs chronic graft failure?
Hyperacute - pre-existent antibodies - rare due to HLA Acute - mismatched HLA, cell mediated, <6 months, reversible Chronic - both antibody and cell mediated, fibrosis of transplanted kidney, potential recurrence of renal disease (MCGN > IgA > FSGS)
38
Features of PKD?
``` Hypertension Recurrent UTIs Abdo pain Renal stones Haematuria CKD ```
39
Extra renal manifestations of PKD?
``` Liver cysts (most common) Berry aneurysms - leading to subarachnoid haemorrhage Mitral valve prolapse Mitral/tricuspid incompetence Aortic root dilation Aortic dissection Cysts in other organs ```
40
Pattern of inheritance with PKD?
Autosomal dominant
41
What is AKI?
Reduction in renal function following an insult to the kidneys
42
Causes of AKI?
``` Prerenal: Hypovolemia Renal artery stenosis Intrinsic: Glomerulonephritis Acute tubular necrosis Acute interstitial nephritis Rhabdomyolysis Tumour lysis syndrome Postrenal: Kidney stone BPH External compression ```
43
Risk factors for AKI?
``` CKD Significant comorbidities History of AKI 65+ Contrast exposure Drugs with nephrotoxic potential: NSAIDs Aminoglycosides ACEi ARBs Diuretics ```
44
Symptoms of AKI?
Reduced urine output Pulmonary and peripheral oedema Arrhythmias Uraemia
45
Factors affecting eGFR?
Pregnancy Muscle mass Eating red meat 12 hours prior to sample
46
What to do for patients at increased risk of contrast-induced AKI?
Offer IV hydration before and after contrast infusion
47
Ascites treatment?
Spironolactone
48
What drugs cause acute interstitial nephritis?
``` Penicillin Rifampicin NSAIDs Allopurinol Furosemide ```
49
How does interstitial nephritis present?
Eosinophilia Mild renal impairment Hypertension Fever, rash, arthralgia
50
Investigation for AKI of unknown aetiology?
Renal ultrasound
51
How to calculate anion gap?
(Sodium + Potassium) - (Bicarbonate + Chloride)
52
ECG changes in hypokalaemia?
U waves T wave flattening ST depression Prolonged PR interval
53
Treatment of mild-moderate hypokalaemia?
2.5-3.4 mol/l | Oral potassium
54
Treatment of severe hypokalaemia?
<2.5 mmol Cardiac monitoring IV fluid therapy No quicker than 20mmol/hr
55
Symptoms of hypokalaemia?
Muscle weakness Hypotonia Predisposes to digoxin toxicity
56
Treatment of nephrogenic diabetes insipidus?
Inability to respond to vasopressin | Give chlorothiazide
57
What is Alport syndrome?
X-linked dominant Abnormal GBM Affects males more than females
58
Symptoms of Alport syndrome?
``` Microscopic haematuria Progressive renal failure Bilateral sensorineural deafness Lenticonus Retinitis pigmentosa ```
59
What is lenticonus?
Protrusion of the lens surface into anterior chamber
60
General management of nephrotic?
Sodium restriction Anticoagulation Statin ACEi - reduce proteinuria
61
Why nephrotic at increased sepsis risk?
Loss of immunoglobulin in the urine
62
Causes of membranous GN?
``` Idiopathic - 75% Panicillamine NSAIDs Mercury Capropril Autoimmune disease Hep B Hep C Schistosomiasis Malaria Malignancy Sarcoidosis Kidney transplantation Sickle cell ```
63
What is thin glomerular basement membrane disease?
Autosomal dominant Microscopic haematuria RBC casts
64
HIV FGS?
Collapsed appearance of glomeruli | Enlarged podocytes
65
What is renal artery stenosis?
Narrowing of the renal artery leading to hypo perfusion and activation of the RAAS
66
Prerenal uraemia
Low urine sodium High urine:plasma osmolality High specific gravity
67
Symptoms of renal artery stenosis?
Abrupt onset hypertension Treatment resistant hypertension Unexplained kidney failure
68
Symptoms of renal artery thrombosis?
``` Sudden onset loin pain Fever Haematuria Nausea + vomiting Sudden drop in kidney function Hypertension ```
69
Symptoms of atheroembolic renal disease?
``` Skin lesions Abdo pain Diarrhoea Confusion Weight loss Fever Muscle aches ```
70
Hyponatremia?
``` <136 mmol/L Asymptomatic if chronic or only mild Anorexia Headache Nausea Lethargy Personality change Muscle cramps Weakness Confusion Drowsiness ```
71
Cause of hypovolemic hyponatremia?
``` Vomiting Diarrhoea Skin losses Renal failure Diuretics Adrenocorticoid deficiency ```
72
Causes of euvolemic hyponatremia?
``` Acute water load Psychogenic polydipsia SIADH Glucocorticoid deficiency Severe hypothyroidism ```
73
Causes of hypervolemic hyponatremia?
``` CCF Cirrhosis Nephrotic syndrome Primary polydipsia Renal failure ```
74
What is SIADH?
Excess ADH secretion from posterior pituitary
75
Treatment of hyponatremia?
Sodium chloride IV for hypovolemic Fluid restrict euvolemic Stop diuretics, SSRIs Treat underlying cause
76
Rapid overcorrection of hyponatremia?
Central pontine myelinolysis
77
What is hypernatremia?
``` >145 mol/L Lethargy Weakness Confusion Jerks Seizures Dry mouth Oliguria Tachycardia ```
78
Causes of hypernatremia?
``` Diabetes insipidus Dementia Burns Loop diuretics Hyperglycemia Iatrogenic Excess salt ingestion ```
79
Treatment of hypernatremia?
Correct fluid loss | Treat underlying disorder
80
Hyperkalemia?
>5.5 but severe >6.5 Palpitations Muscle weakness Depressions reflexes
81
Causes of hyperkalemia?
Decreased excretion Increased circulation Extracellular shift Pseudohyperkalemia
82
ECG of hyperkalemia?
``` Peaked T waves Prolonged PR Widened QRS Loss of P wave AV dissociation ```
83
Hyperkalemia management?
``` Calcium glutinate Insulin/dextrose infusion Salbutamol nebuliser Calcium resonium Loop diuretic Dialysis ```
84
What is metabolic acidosis?
pH <7.35 | Bicarbonate <22
85
Causes of normal anion gap metabolic acidosis?
``` GI bicarb loss Renal tubular acidosis Drugs Addison's disease Ammonium chloride ```
86
Causes of raised anion gap metabolic acidosis?
Lactate: shock, hypoxia Ketones: DKA, alcohol Urate: renal failure Acid poisoning: salicylates, methanol
87
What is a normal anion gap?
10-20
88
Symptoms of metabolic acidosis?
``` No ACID Nausea Arrhythmias Confusion Increased heart rate + RR Diarrhoea ```
89
Treatment of metabolic acidosis?
Treat underlying cause
90
Drugs causing minimal change?
NSAIDs Interferon Lithium
91
Drugs causing FSGS?
Bisphosphonates | Heroin
92
Drugs causing membranous?
NSAIDs Gold Penicillamine
93
Drugs causing acute tubular injury?
``` NSAIDs Aminoglycosides Amphotericin B Zoledronic acid IV contrast ```
94
Drugs causing interstitial nephritis?
NSAIDs Antibiotics Allopurinol PPI
95
Drugs causing HUS or TTP?
Ciclosporin Clopidogrel Gemcitabine Bevacizumab
96
Drugs causing rhabdomyolysis?
Statin | Cocaine
97
Risks of raised creatine?
Increased hospital mortality Risk of CKD Progression to ESRF
98
Stage 1 AKI?
Creatinine 1.5-1.9x baseline | Urine <0.5ml/kg/hr for 6-12 hours
99
Stage 2 AKI?
Creatinine 2-2.9x baseline | Urine <0.5ml/kg/hr for >12 hrs
100
Stage 3 AKI?
Creatinine 3x baseline | Urine <0.3ml/kg/hr for 24 hrs or anuria >12 hours
101
Investigations for AKI?
``` Urinalysis Urine MSC Blood gases Renal ultrasound ECG Immunology screen ```
102
Findings of acute tubular necrosis?
High urine sodium Low urine:plasma osmolality Low specific gravity Brown granular casts
103
What drugs can worsen AKI?
``` NSAIDs Aminoglycosides ACE inibitors ARBs Diuretics ```
104
Other drugs stopped in AKI?
Metformin Lithium Digoxin
105
CKD stage one?
Kidney disease but normal GFR
106
CKD stage 2?
Kidney disease | GFR 60-89
107
CKD stage 3?
GFR 30-59
108
CKD stage 4?
GFR 15-29
109
CKD stage 5?
GFR <15
110
Mainstay of CKD treatment?
Prevent loss of kidney function optimise glycemic control Blood pressure - ACE Lipid lowering agent
111
Peritoneal dialysis?
Infusion of dialysis fluid into peritoneal cavity Exchange occurs with highly vascular omentum Fluid replaced to remove waste
112
Complications of peritoneal dialysis?
``` Peritonitis Constipation Fluid retention Hernia Back pain Malnutrition Depression Catheter problems: infection, blockage, kinking, leaks ```
113
Other management of patients on dialysis?
Phosphorus binding agents Alfacalcidiol Calcimemetics
114
Haemodialysis?
Through a fistula or central line | Ultrafiltration removes waste and adds any necessary products
115
Complications of haemodialysis?
``` Infection Hypotension Cardiac arrhythmias Nausea vomiting Fever Dialyser reactions Heparin induced thrombocytopenia Depression ```
116
Contraindications to transplant?
``` Cancer Infection Uncontrolled ischaemic heart disease HIV Viral hepatitis Extensive peripheral vascular disease Mental incapacity ```
117
Pros of transplant?
Stop dialysis Improved quality of life Normal diet + activity Reversal of anaemia and bone disease
118
Cons of transplant?
``` Operative complications Graft failure Thrombosis in transplant Infection Cancer Immunosuppression effects ```
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