Renal injury Flashcards
Aetiology of acute tubular necrosis
Damage to tubular epithelium → obstruction of blood flow → renal failure
Hypovolaemia (shock, sepsis)
Toxins
- Myoglobin (rhabdo)
- Immuno (multiple myeloma)
- Drugs e.g. NSAIDs, aminoglycosides
- CT contrast
Features of acute tubular necrosis
Features of AKI: raised urea, creatinine, potassium
Muddy brown casts in the urine
Aetiology of acute interstitial nephritis
Interstitial oedema and infiltrate in the connective tissue between tubules
Causes:
- Bacteria e.g. E. Coli, Hanta virus, Staph
- Systemic Illness e.g. SLE, sarcoidosis, Sjogren’s
- Drugs e.g. penicillin, rifampicin, NSAIDs, allopurinol, furosemide
Tubulointerstitial nephritis with uveitis (TINU) usually occurs in young females. Symptoms include fever, weight loss and painful, red eyes. Urinalysis is positive for leukocytes and protein.
Features of acute interstitial nephritis
Fever, rash, arthralgia
Eosinophilia
Mild renal impairment
HTN
STERILE pyuria
White cell casts
Aetiology of haemolytic uraemic syndrome
Damage to the endothelium of the glomerular capillary bed
Caused by infection with Shiga toxin-producing strains of E. coli (STEC HUS)
- EHEC 0157:H7 - E coli infection (gastroenteritis) → bloody diarrhoea, abdominal pain
- From contaminated water, meat, dairy products or contact with farm animals
Also caused by streptococcal species, shigella, HIV
Secondary HUS: drugs e.g. OCP, ciclosporin, chemotherapy agents, cancer agents, bone marrow transplant and pregnancy
Features of Haemolytic uraemic syndrome
AKI
thrombocytopenia
MAHA
Blood film: schistocytes
FBC: anaemia, thrombocytopenia
Coomb’s: negative
U&Es: AKI
Stool culture: STEC infection
Features of thrombotic thrombocytopenic prupura
AKI
Thombocytopenia
MAHA
Fever
CNS signs
Aetiology of thrombotic thrombocytopenic purpura
ADAMT3 deficiency -> abnormally large sticky multimers of vWF -> platelet thrombi
Secondary to: infection, pregnancy, tumours, SLE, HIV
