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Renal medicine Flashcards

(38 cards)

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1
Q

Definition of AKI

A

Creatinine: Rise >26 umol in 48h OR >1.5x baseline in 7d

Urine output: <0.5ml/kg/hr for >6h

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2
Q

Pre-renal causes of AKI

A

Urea often disproportionately high

  • Reduced vascular volume: D&V, pancreatitis, burns, haemmorhage, rapid diuresis after relieving obstruction
  • Reduced CO: Cardiogenic shock, MI
  • Systemic vasodilation: Sepsis, anaphylaxis, anti-HTNs
  • Drugs: Diuretics, ACEi, NSAIDs, angiotensin receptor blockers
    *
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3
Q

Renal causes of AKI

A

Creatinine:urea approx 10 (proportional rise)

  • Glomerulonephritis:
  • Interstitial nephritis​
  • Tubular necrosis​
  • Vascular:
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4
Q

Post-renal causes of AKI

A
  • Intrarenal:
    • LC preceipitation (myeloma)
    • Urate crystals (tumour lysis syndrome)
    • Drugs (causing crystalluria): Acyclovir, sulphanomides, NSAIDs
  • Upper tract obstruction:
    • Renal calculi (stones): e.g. hypercalcaemia
    • Carcinoma of bladder, colon, renal tract
    • Retro-peritoneal fibrosis
    • Acute pyelonephritis (esp. in DM)
  • Urethral obstruction:
    • Urethral strictures
    • Prostatic hypertrophy
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5
Q

Signs and symptoms of AKI

A
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6
Q

Definitions of CKD

A
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7
Q

Staging CKD

A
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8
Q

Symptoms of AKI

A

REDUCED URINE OUTPUT

Nausea, vomiting, hiccups

Fatigue, malaise

Breathlessness (acidosis/pulmonary oedema)

Peripheral oedema

Haematuria

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9
Q

Emergency scenarios with AKI/ARF (what will kill patients)

A
  • Hyperkalaemia (K > 6.5)
  • Pulmonary oedema
  • Metabolic acidosis
  • Hypertensive encephalopathy (fundi, coma score, reflexes)
  • Uraemic encephalopathy (asterixis)
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10
Q

Management of hyperkalaemia

A

Calcium gluconate

Dextrose (50%) + insulin

ECG monitor + IV access

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11
Q

Management of pulmonary oedema

A

Sit upright

High-flow oxygen

Furosemide IV

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12
Q
A
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13
Q

Distinguishing features of CKD vs AKI

A

Anaemia

Osteodystrophy/VitD/Ca deficiencies

Small, scarred kidneys on CKD

Timescale

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14
Q

Features of post-renal AKI

A

Complete anuria

Dysuria, poor stream beforehand

Distended bladder

Constipation, prostate hypertrophy

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15
Q

Criteria for renal team referral

A
  • AKI not responding to treatment
  • Complications: ↑k+, acidosis, fluid overload
  • stage 3 aki (>3x baseline, Cr >350)
  • Difficult fluid balance (eg hypoalbuminaemia, heart failure, pregnancy)
  • Possible intrinsic renal disease (table 7.4)
  • Hypertensive encephalopathy
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16
Q

Investigations for AKI

Study These Flashcards
A
  • B: U+E, VBG, FBC
  • O: Urine dipstick (pre-catheter), urine output monitorin
  • X: USS KUB
  • E: ECG monitoring if hyperkalaemic
  • S: Intrinsic renal disease if indicated (Abs, myeloma, etc…)
17
Q

Management

Study These Flashcards
A

Fluid resuscitation

Catheterisation/(?nephrostomy for higher-level obstruction)

Stop nephrotoxic medications

Change medication doses for renal impairment

Biopsy if intrinsic renal disease

18
Q

Signs of hypovolaemia

Study These Flashcards
A

Low BP (NB: compare to baseline)

Low skin turgor

Dry mucous membranes

Low urine output

Weight loss

Tachycardia

Low CRT

19
Q

Signs of fluid overload

Study These Flashcards
A

High BP

Bilateral crepitations/breathlessness

Raised JVP (NB: Not valid in RHF)

Gallop heart rhythm

Peripheral oedema

20
Q

Vascular causes of renal AKI

Study These Flashcards
A

Vasculitis

DIC

TTP

HUS

21
Q

Causes of acute tubular necrosis

Study These Flashcards
A
  • ​Ischaemia (prolonged renal hypo-perfusion, acute thrombotic event)
  • Toxins/pigments
  • Rhabdomyolysis/hypercalcaemia
  • Drugs:
    • Gentamicin, penicillins
    • Diuretics, ACEi
    • NSAIDs, cyclosporin
    • Contrast agents, anaesthetics
22
Q

Causes of interstitial nephritis

Study These Flashcards
A

​Drugs (allergic-type reaction): Penicillins, cephalosporins, rifampicin, NSAIDs

Infection

Infiltration (e.g. sarcoid)

23
Q

Common causes of CKD

Study These Flashcards
A

Diabetes

Hypertension

Glomerulonephritis

24
Q

Definition of CKD

Study These Flashcards
A

Abnormal renal structure/function for >3mo

Criteria: Albuminuria, low eGFR

25
HOPC questions for CKD
Recent/recurrent UTI Lower UT symptoms Oedema: SOB, swelling N+V, anorexia, restless legs Autoimmune: Eyes, skins, joints Myeloma/malignancy: Bone pain, B-symptoms, anaemia When did you last feel well?
26
Peripheral examination in CKD
Peripheral oedema Vasculitic rash/pruritus scratch-marks Signs of peripheral vascular disease Uraemic flap
27
Facial examination in CKD
Anaemia Xanthalesama Gum hypertrophy (ciclosporin) Cushingoid (steroids) Periorbital oedema (nephrotic syndrome) Telangiectasia (scleroderma) Facial lipodystrophy (glomerulonephritis)
28
Neck/chest examination of CKD
JVP Central line scars Pulmonary oedema/pleural effusion Sternotomy scars Cardiomegaly
29
Bone profile results of CKD
Hypocalcaemia Hyperphosphataemia Hyper-PTH Vit D deficiency
30
Indications for long-term dialysis
Inability to control symptomss: * Fluid status (oedema) * Electrolye/acid-base disturbances * N+V/nutrition * Pruritus * Inability to control BP * Cognitive impairment
31
Complications of A-V fistulae
Thrombosis Stenosis Vascular steal syndrome (distal blood flow)
32
Complications of central venous catheter
Infection Blockage Blood recirculation
33
Complications of peritoneal dialysis
Catheter site infection PD peritonitis Hernias Loss of membrane f(x) with time
34
General complications for dialysis patients
Haemodynamic instability/hypotension (c.f. not on haemofiltration) Dialysis dysequilibrium (imbalance between cerebral and vascular solutes --\> oedema --\> need gradual start) High mortality from CV disease (poor BP control, deranged Ca/phosphate, oxidative stress/inflammation) Uraemia --\> granulocyte/T-cell dysfunction --\> \> sepsis mortality Renal osteodystrophy
35
What to ask about/check for dialysis patients?
K+ and fluid status Normal urine output and target weight Next scheduled dialysis Dose-adjustments IV access considerations w/ fistulas Troponin has low Sp in ESRF
36
Contraindications to renal transplant
Absolute: Cancer w/ mets Temporary: Active infection, unstable CVD Relative: CHF, CVD
37
Immunosuppressive medications for transplant patients
* Monoclonal antibodies * Calcineurin inhibitors (e.g. tacrolimus) * Glucocorticosteroids * Antimetabolites (e.g. azathioprine, mycophenolic acid)
38
Questions for renal transplant presentation
eGFR/creatinine + comparison to baseline Check for macrolide/calcineurin interactions Adjust doses to renal function Correct AKI promptly Consider opportunistic infection Discess VTE prophylaxis w/ transplant unit Ensure immunosupression even if need to give IV/NG

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