What is nephrolithiasis?
- Presence of calculi within the urinary tract.
What is the clinical presentation of nephrolithiasis?
- Severe, acute loin to groin pain. (Renal-colic).
- Commonly associated with nausea and vomiting.
What are the risk factors for nephrolithiasis?
- Male.
- Dehydration.
- High salt intake.
- Obesity.
What is the most common type of renal stone?
- Calcium oxalate.
Which renal stones are radiolucent?
- Urate stones.
What are all 5 types of renal stone?
- Calcium oxalate (most common).
- Calcium phosphate.
- Uric acid.
- Cysteine.
- Struvite.
What is the first line investigation for suspected kidney stones?
- Non-contrast CT of KUB.
What is the treatment for nephrolithiasis?
If smaller:
- Ibuprofen
- Watch and wait, hope the stone passes.
If larger (>10mm): - Shock wave lithotripsy (SWL).
If there is obstruction:
- Insert uteric stent to drain/decompress the urinary tract.
What is AKI?
- Acute decline in kidney function.
What are the key diagnostic features of AKI?
- Raised creatinine/urea.
- Decreased urinary output/GFR.
What are the 3 types of AKI? 2/3 examples of each.
Pre-renal:
- Heart failure
- Hypovolaemia (hypotension).
- Overdiuresis (too many diuretics given).
Renal:
- Glomerulonephritis.
- Acute tubular necrosis.
Post-renal:
- BPH.
- UTI.
- Renal stones (cholelithiasis).
How do arterioles in the kidney affect the GFR?
Afferent go towards the glomerulus. Efferent go away from the glomerulus.
- Dilate afferent and constrict efferent to increase GFR.
- Constrict efferent and dilate afferent to decrease GFR.
What are the nephrotoxic medications?
Which drug specifically is SAFE in CKD/AKI?
“DAMN” + gentamycin. Cause drug-induced AKI.
- Diuretics.
- ACEi/ARBs
- Metformin
- NSAIDs.
- PARACETAMOL IS SAFE IN AKI.
What electrolyte changes are commonly seen in AKI?
- Hyperphosphataemia.
- Hyperkalaemia.
- Metabolic acidosis.
What is the treatment for AKI?
- Stop nephrotoxic drugs (DAMN + gentamycin).
- Give fluids for hypovolaemia.
- If there are electrolyte imbalances, RRT (renal replacement therapy/dialysis).
What is CKD?
Abnormal kidney structure/function that has been present for over 3 months.
How does CKD present?
Often asymptomatic in the early stages.
Can present with:
- Oedema (fluid overload due to low GFR).
- Nausea.
- Pruritus (due to hyperphosphataemia).
- Restless leg syndrome (anaemia due to low EPO production).
What is the most common cause of CKD?
- Diabetes mellitus. Causes DKD (a form of CKD).
How is GFR classified?
Stage 1: GFR>90 Stage 2: GFR 60-89 Stage 3a: GFR 45/58 Stage 3b: GFR 30-44 Stage 4: GFR 15-29 Stage 5 (Kidney failure): GFR <15.
What are the investigations used to diagnose CKD?
- Creatinine/urea. Raised
- Estimated GFR. Low.
- Urinalysis. Haematuria and proteinuria.
What is the treatment for CKD?
- ACEI is first line for control of hypertension (e.g. ramipril).
For renal failure (stage 5 kidney disease):
- RRT (renal replacement therapy such as dialysis).
- Kidney transplant.
What is calcium gluconate used for?
To stabilise the cardiac membrane when the patient is hyperkalaemic.
What is nephrotic syndrome?
- Kidney disease characterised by proteinuria and hyperphosphataemia.
What is nephritic syndrome?
- Kidney disease associated with haematuria, and a raised BP.
