Renal Long Flashcards
(45 cards)
1
Q
Causes of CKD
A
- DM - 33%
- GN - 24%
- HTN - 14%
- PCKD - 7%
- Reflux nephropathy
- Analgesic nephropathy
- Uncertain
2
Q
RF for progression of CKD
A
- Low birth weight
- HTN
- AKI
- Proteinuria
- Smoking
- Hyperuricaemia
- An increase in glomerular pressure (pregnancy, obesity, diabetes)
3
Q
Early Sx of renal failure
A
Nocturia Lethargy Loss of appetite Fluid retention Pruritis
4
Q
Sx of Severe CKD
A
Pericarditis Serositis Encephalopathy GI bleeding Uraemic neuropathy
5
Q
Precipitants of AKI
A
NSAIDS Contrast Infection ACE/ARB Dehydration Anaemia
6
Q
Sx/Signs to screen for GN
A
Proteinuria Haematuria Oliguria Oedema Sore throat Sepsis Rash Haemoptysis
7
Q
IgA nephropathy associations
A
HIV
CLD
IBD
Coeliac
8
Q
Causes of membranoproliferative GN
A
Hep C Autoimmune disease Indolent infections (malaria, syphilis) Essential Cryoglobulinaemia Malignancies Drugs - penacillamine, NSAIDS, anti TNF drugs Mercury/gold poisoning
9
Q
Causes of FSGS
A
Primary Familial HIV infection Morbid obesity Heroin use Reflux nephropathy
10
Q
PCKD Hx Questions
A
FHx Haematuria Polyuria Loin pain HTN Renal calculi Headache/SAH/visual disturbance Diverticular disease Hernias
11
Q
Principles of Mx of CKD
A
- Fluid intake and diet
- Anaemia
- Acidosis
- Phosphate/calcium/bones
- CVS risk
- Consider vascular access
- Consider when to start dialysis
- Consider suitability for Tx
12
Q
General Dialysis questions
A
- Where is it performed
- How often
- How many hours per week
- Relief of Sx with treatment
- Complications with dialysis
- On transplant list
13
Q
CKD conservatively managed patients - Sx questions
A
Anaemia Bone disease Secondary gout/pseudogout Pericarditis HTN Cardiac failure Fluid overload Peripheral neuropathy Pruritis Peptic ulcers Impaired cognitive function Poor nutrition
14
Q
HDx History questions
A
How long have they been on HDx?
Where do they dialyse? - Transport if satellite unit
What is the current dialysis prescription?
-Frequency, duration, dry weight, fluid removed
-Pre and post HDx BP
-Anticoagulation apart from heparin given during HDx
-Recent changes to presciption
What is the patient’s dialysis access Hx?
Any symptoms on or after dialysis?
15
Q
PDx Hx Questions
A
CAPD vs APD?
How long have they been on PD
Infections of PD side or peritonitis
Still passing urine?
16
Q
Renal Tx Questions
A
- Graft pain or swellin
- Infections
- Urine leaks
- Steroid and immunosuppression side effects
- Proteinuria and Cr level
- Avascular necrosis
- Skin cancer
- Reflux nephropathy
- Recurrent GN
17
Q
CKD causes that have normal or enlarged kidneys
A
- Early diabetic nephropathy
- PCKD
- Obstructive uropathy
- Acute renal vein thrombosis
- Amyloidosis
- Rarely other infiltrative diseases eg. lymphoma
18
Q
CKD Ix
A
- Determine renal function
- egfr
- Tubular function: electroltes, pH, uric acid, calcium, albumin
- Urinalysis and PCR - Determine renal structure
- USS - size and symmetry, signs of obstruction
- Renal artery doppler
- CT - RAS, obstruction, CT renal angiography
- Cystoscopy and retrograde pyelography - Effects of CKD
- FBE, Iron studies, CMP, PTH
- Nerve conduction studies - Assess for underlying disease
- ANA, ANCA, Hepatitis, HIV, complement, SPEP, FLC, urine cytology
- Renal Bx
19
Q
Approach to Tx of CKD
A
- Treat reversible causes of deterioration
- BP and lipid control
- Diet: Salt and water restriction
- Normalise calcium and phosphate - diet or meds
- Treat acidosis if needed
- Anaemia Mx
- Dialyse when indicated
- Consider Tx
20
Q
Common Complications of Dialysis
A
Sudden cardiac death
Vascular disease
Extravascular calcification - AS, calciphylaxis
Amyloidosis
21
Q
Kidney donation options
A
DBD
DCD
Live family donor
Pared kidney exchange
22
Q
Renal Tx Hx
A
- Cause of original renal failure and duration of transplant in situ
- Source of transplant
- Previous rejection episodes and how they were managed
- Graft Biopsies
- Immunosuppressive medication changes and side effects
- Patient and donor CMV status
- IHD/PVD
- Infections
- Malignancy
23
Q
SE of Ciclosporin
A
Hirsutism Gingival hypertrophy Tremor Diarrhea Neurotoxicity Renal impairment Hypomagnesmia LFT derrangement HTN Chol Gout Hyperkalemia
24
Q
SE of everolimus/sirolimus
A
Proteinuria Hyperlipidaemia Pneumonitis Tendon rupture oedema Impaired wound healing Cytopenias
25
Absolute contraindications to Renal Tx
- Malignant disease (need 2 years of remission after treatment before consideration)
- Severe IHD
- Active vasculitis or anti basement membrane disease
- Occulsive aortoiliac disease
- Continuing sepsis
26
Relative contraindications to Renal Tx
Older than 75 yo
High risk of recurrence in Tx
Ureteric or bladder disease
Other co-morbidities
27
Causes of chronic renal rejection
- Chronic allograft nephropathy
- Recurrent GN (especially FSGS and membranous)
- De novo GN
- Chronic AMR
28
PCKD Diagnostic Criteria
- Diagnostic criteria in those with a family history of PCKD
○ At least 3 unilateral or bilateral kidney cysts if age 15-39
○ At least 2 cysts in EACH kidney in persons age 40-59
○ Four or more cysts in EACH kidney in persons age 60 or older
- If NO family history
○ Need >10 cysts in each kidney and no features to suggest any other cystic disease
Genetic testing not routinely offered unless atypical case
29
DDx HAematuria
```
Stones
Infection
GN
Malignancy
Bleeding predisposition
Drugs - cyclophosphamide
```
In transplant
- BK virus
- Disease recurrence
30
Steroid Cx
```
Diabetes
HTN
Chol
Altered fat distribution
Oedema
Cataracts
Bones
Mood and insomnia
```
31
MMF SE
Diarrhea
| Cytopenia
32
Tacrolimus SE
```
Alopecia
Diarrhea
Neurotoxicity
Tremor
Hypomagnesemia
Hyperkalemia
Gout
Nephrotoxiity
Diabetes
HTN
chol
```
33
Causes of renal anaemia
1. Decreased EPO production
2. Iron deficiency
- Decreased absorption
- Loss: Dialysis, anticoagulation, reduced RBC life span
- Increased iron demand with EPO supp
3. Uraemic inhibitor - Decreased bone marrow function
4. Inflammation: increased hepcidin
34
Tx of chronic hyperkalemia in CKD
1. Decreased K+ Diet
2. W/H relevant drugs
3. Improve glycemic control
4. Correct acidosis
5. Resonium
35
Tx of Acidosis in CKD
Sodium bicarg
-SE: Hypokalemia and fluid iverload
Dialysis
36
Tx of Uraemia in CKD
Itch
- Emollients
- Control CKD MBD
Nausea: Antiemetics
Dialysis
37
Tx of CVS risk in CKD
BP
- Target if non proteinuric: <140/90
- Target if proteinuric: <130/80
- Life style:
- -Reduce salt intake <2 grams per day
- -Exercise
- -Weight loss
- Pharm:
- -ACEi
Statin
-if 50 + yo w/ CKD
if 18-49 yo w/ DM/IHD/Stroke
38
Considerations when choosing a dialysis modality
1. Longevity vs QOL
2. PAtient lifestyle
3. Functional ability
4. Carer availability
5. Tolerability - cardiac issues
6. Transport/geographical issues
7. Home environment
8. Previous abdo surgery, hernia
39
Mx of acute cell mediated rejection
1. Methlypred
| 2. Thymoglobulin/ATGAM
40
Mx of AB mediated rejection
MEthylpred
PLEX
IVIG
Rarely thymoglobulin/rituximab
41
MX of Chronic rejection
Aims:
1. Early detection
- Surveillance
2. Prevention
- Adherence
- Drug level monitoring
- Absorption issues
42
Factors to consider for risk of rejection
1. Graft function - baseline and present
2. HLA mismatch
3. DSA, past sensitising Hx
4. Previous REnal Bx
5. Adherence/absorption
43
Approach to any issues post transplant
Consider:
- Basics
- Meds
- Infection
- Malignancy
44
Prophylaxis time lines post Tx
1-2 months: Nystatin/amphoterecin
3-6 months: Valganciclovir --> if leukopenia, the nvalaciclovir
6 months -->Bactrim (PJP, norcardia, Toxo) ---> alternatives: Dapsone, pentamidine
45
Immunosuppression Cx
- CVS risk
- Cytopenias, drug levels, drug interactions
- Bone health
- Infection risk - vaccines
- Malignancy
