Renal harder notes

Question 1

What is the criteria for a diagnosis of an AKI

Answer 1

1. > 25mmol increase of creatinine in 48 hours
2. > 50% increase in creatinine in 7 days
3. UO is less than 0.5ml/kg/hour

Question 2

What are the stages of AKI?
a) Stage 1
b) Stage 2
c) Stage 3

Answer 2

a) Stage 1- creatinine 1.5-2
b) Stage 2- 2-2.9
c) Stage 3- >3

Question 3

What is Chronic Kidney Disease?

Answer 3

Reduction in kidney function > 3 months

Question 4

What are classifications required for there to be a diagnosis of Chronic Kidney Disease?

Answer 4

1. Estimated glomerular filtration rate (eGFR) is sustained below 60ml/min
2. Urine albumin: creatinine ratio is above 3mg/mmol

Question 5

What is the management of AKI?

Answer 5

1st line- stop ACEI/ARB (* or any other nephrotoxic drugs)
2nd line- IV sodium chloride

Question 6

What is the management of CKD?

Answer 6

1st line- start ACEI/ARB
2nd line- add on an SGLT-2 inhibitor

Question 7

What are these buzzwords associated with?
a) ‘white cell casts’
b) ‘muddy brown casts’

Answer 7

a) acute interstitial nephritis
b) acute tubular necrosis (brown as necroses)

Question 8

What is the MOST common cause of an intrinsic AKI

Answer 8

Acute tubular necrosis

(*Muddy brown casts- on microscopy)

Question 9

What is acute interstitial nephritis?

Answer 9

This is kidney inflammation commonly caused by medications.

Most common drug causes:
-NSAIDs
-Antibiotics
-PPIs
-Diuretics

Question 10

What are the x2 main symptoms associated with Alports Syndrome?

Answer 10

haematuria
sensorineural hearing loss
-Type IV (4) collagen defect, X-linked recessive

Question 11

What is the 1st line investigation for PCKD?

Answer 11

1st line- US (priority) + genetic testing

Question 12

What is the gold standard investigation for Alport’s syndrome?

Answer 12

1st line- genetic testing
2nd line- renal biopsy (shows ‘splitting of the lamina dense’)

Question 13

What is the gold standard investigation of good pastures syndrome?

Answer 13

gold standard diagnostic- renal biopsy (IgG deposits)

Question 14

What is the 1st line management of Goodpastures syndrome?

Answer 14

1st line- plasmapheresis (remove the Anti-GBM)

Question 15

What type of anaemia is anaemia of chronic kidney disease?

Answer 15

normocytic anaemia

Question 16

What is the management of chronic kidney disease?
(*what are the special rules)

Answer 16

(*RULE- ALWAYS replace iron deficiency before restoring erythropoietin)

1st line- iron replacement
types:
-not on haemodialsyis- oral iron
-on haemodialysis- IV iron
2nd line- erythropoieten injections

Question 17

What are the special rules in treating osteoporosis?

Answer 17

Must treat the calcium and vitamin D levels before giving biphosphonates!

Question 18

What is the 1st line investigation for diabetic nepropathy?

(*nepropathy- kidneys)

Answer 18

1st line- urinary albumin:creatinine ratio

Question 19

What is fibromuscular dysplasia?

Answer 19

This is renal artery stenosis caused by atherosclerosis

Question 20

What is the 1st line investigation for focal segmental glomerulosclerosis?

Answer 20

1st line- renal biopsy and microscopy

Question 21

What is the management of Nephrotic Syndrome?

(minimal change disease, focal segmental glomerulosclerosis)

Answer 21

1st line- oral prednsolone
2nd line- immunosuppressants (*If steroid resistance is present)

Question 22

what renal condition is assoicated with “tram track appearance”

Answer 22

membranoproliferative glomerulonepritis

Question 23

What is the gold standard diagnostic investigation for minimal change disease

Answer 23

gold standard- renal biopsy, fusion of podycytes at the foot processes

Question 24

‘starry sky appearance’ this is a buzzword for what conditions in these topics

Answer 24

a) haematology- burketts lymphoma
b) renal- post-strep glomerulonephritis

Question 25

'red cell casts' this is a buzzword for what condition?

Answer 25

rapidly progressing glomerulonephritis

Question 26

What is the pathophysiological process for Rhadbomyolysis?

Answer 26

acute tubular necrosis

Question 27

What is the management of high phosphate levels? B) what are complications of having elevated phosphate long term

Answer 27

1st line- vitamin d complication- it can cause osteomalacia

Question 28

What is the 1st line investigation for suspected Diabetic Nepropathy?

Answer 28

albumin:creatinine ratio (*morning specimen)

Question 29

What are the different stages of Chronic Kidney Disease?

Answer 29

(measured by eGFR levels- 30 and 15 intervals) stage 1- >90 stage 2- 60-90 stage 3a- 45-60 stage 3b- 30-46 stage 4 <30

Question 30

What acid base disorder is AKI associated with?

Answer 30

metabolic acidosis

Question 31

What x2 medications should be stopped in an AKI? they do not cause renal damage tho!

Answer 31

Lithium and metformin

Question 32

What medication should you continue in an AKI

Answer 32

aspirin- cardio-protective dose

Question 33

what must be present alongside stage 1 and 2 AKI

Answer 33

other evidence- like elevated creatinine, etc

Question 34

What is the best investigation for suspected CKD after bloods

Answer 34

albumin: creatinine ratio (early morning specimen)

Question 35

What are the x3 main types of causes of AKIs? -give examples

Answer 35

Acute Kidney Disease: 1) Pre-renal- hypovolemia, dehydration, medications 2) Renal- acute tubular necrosis- most common cause of an AKI 3) Post-Renal Obstruction- in ureter, kidney stones, stricture, BPH, cancer

Question 36

What is the diagnostic criteria for an AKI? (*learn this do NOT be lazy)

Answer 36

Diagnostic Criteria: 1. >26mmol/L in 48hrs 2. >50% rise in creatinine over 7 days 3. Urine output falls <0.5,l/kg/hr

Question 37

What is the staging criteria for an AKI?

Answer 37

Stage 1- Increase in creatinine 1.5-1.9 times baseline Stage 2- increase in creatinine of 2-2.9 times baseline Stage 3- Increase in creatinine >3 times the baseline

Question 38

What are the most common medication causes of acute interstitial nephritis?

Answer 38

drugs: the most common cause, particularly antibiotics penicillin rifampicin NSAIDs allopurinol furosemide

Question 39

Eosinophillia is assiociated with which renal condition?

Answer 39

acute interstitial nephritis

Question 40

What are the electrolyte imbalances in rhabdomyolysis

Answer 40

-elevated CK -hyperkalemia -myoglobuniura -metabolic acidosis Management: IV sodium chloride

Question 41

What prophylactic treatment is needed for nephrotic syndrome

Answer 41

LMWH- due to inc risk of VTE

Question 42

What electrolyte imbalance is an indication for dialysis

Answer 42

LOW bicarbonate