Renal Flashcards by Phoebe McCarthy

What is urine output criteria for AKI stages?

AKI 1 - <0.5mL/kg/hr for 6 hours

AKI 2 - <0.5mL/kg/hr for 12 hours

AKI 3 - <0.3mL/kg/hr for 24 hours
OR
Anuria for 12 hours

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What is serum creatinine criteria for AKI stages?

AKI 1 - Increase ≥ 26 μmol/L within 48 hours
OR
Increase ≥ 1.5-1.9 fold from baseline

AKI 2 - Increase ≥ 2-2.9 fold from baseline

AKI 3 - Increase ≥ 3 fold from baseline
OR
Increase ≥ 354 μmol/L
OR
Initiated on renal replacement therapy (RRT)

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What are some pre-renal causes of AKI (4)?

Volume depletion (blood loss, dehydration, burns)
Reduced BP (shock, cardiogenic shock, meds)
Reduced vascular perfusion (renal artery stenosis)
Renal vasoconstriction (ACEi/NSAIDs)

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What are some intra-renal causes of AKI?

Vascular (vasculitis, HUS)
Glomerular (glomerulonephritis)
Tubular disease (acute tubular necrosis, multiple myeloma, rhabdomyolysis)
Interstitial nephritis (new drug hypersensitivity)

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What are the post-renal causes of AKI?

Intrinsic obstruction (malignancy, stones, stricture)
Extrinsic compression (BPH, pelvic malignancy, retroperitoneal fibrosis)
Acquired (blocked catheter)

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Urine dip correlation to different causes of AKI? (Pre/intra/post renal)

Pre = no blood, no protein
Intra = blood +/- protein
Post = blood or leucocytes, no protein

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Urine osmolality in different causes of AKI? (Pre/intra/post renal)

Pre = Urine osm high, urine Na low
Intra = Urine osm low, urine Na high
Post = Urine osm low/normal

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Symptoms of AKI?

Vague/non-specific due to biochem disturb:
Oliguria/Anuria
Abdo pain
Dizziness/headache
Nausea/vomiting

+/-
Signs of dehydration
Signs of shock
Signs of vasculitis
Abdominal distension

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Management of a patient in AKI?

ABCDE
Stop nephrotoxic drugs
Assess and manage fluid status
Assess and manage electrolytes imbalances
Refer to urology

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Risk factors for AKI (4)?

Underlying conditions - CKD, HF, liver dx, DM
Dehydration - elderly, kept NBM
Acute conditions - sepsis, cardiac surgery
Meds - NSAIDs, ACEis, gentamicin, contrast medium, lithium

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Complications of AKI (6)?

Hyperkalaemia
Fluid overload
Pulmonary oedema
Metabolic acidosis
Uraemia

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Indications for dialysis in AKI?

Life-threatening, refractory AKI:
Severe uraemia/Hyperkalaemia/Metabolic acidosis
Pulmonary oedema refractory to treatment
Toxins

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How to manage severe hyperkalaemia?

Calcium gluconate (stabilise myocardium)
IV glucose and insulin (drive K+ into cells)
Salbutamol nebs (drive K+ into cells)
Sodium bicarbonate (correct acidosis)
Treat cause

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Investigations in AKI (6)?

History + exam
Urine dip
Further urinalysis
Bloods
ABG
ECG
Renal USS or CT KUB

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What is included in a nephritic blood screen?

ANCA (vasculitis
ANA/ds DNA (SLE)
Complement (low in infection/SLE)
Hep B and C

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What is chronic kidney disease (CKD)?

Progressive and irreversible damage to renal function (>3m)

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What are the CKD stages according to eGFR?

1 = >90
2 = 60-89
3a = 45-59
3b = 30-44
4 = 15-29
5 = <15

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What are the CKD stages according to albuminuria?

A1 = <3mg/mmol
A2 = 3-30mg/mmol
A3 = >30mg/mmol

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What are some causes of deteriorating GFR (5 - not aki/ckd)?

Diabetes
HTN
Chronic glomerulonephritis
Chronic pyelonephritis
Polycystic kidney disease

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What are some risk factors for CKD decline (5)?

HTN
DM
Smoking
Infection
NSAIDs/ACEi

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What are some signs on examination or investigations of declining kidney function (CKD) (6)?

Anaemia
Bone disease
Hyperkalaemia
Fluid overload
Uraemia
Metabolic acidosis

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Investigations for CKD (6)?

BP
Urine dip (ACR)
Bloods - U&Es, bicarb, Hb, PTH, glucose
USS kidney
Renal biopsy (if unsure cause)
CXR

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When should ACE inhibitors be initiated in CKD?

If ACR >30mg/mmol
If concurrent HTN and CKD

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What meds are prescribed for risk reduction in CKD (3)?

ACEi/ARB - BP control
Statins
DM control

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What lifestyle factors should be implemented in CKD?

Stop smoking Weight management Low salt/phosphate diet

Which type of anaemia is often seen in CKD?

Normocytic, normochromic anaemia (due to reduced erythropoietin)

How is anaemia treated in CKD?

Iron (oral unless on EPO/dialysis > IV) If levels not met in 3m > IV EPO stimulating agents (if needed)

How is bone disease in CKD managed?

Vit D and calcium supplements Phosphate binders

Why are phosphate binders given in CKD?

Reduce kidney function = phosphate not excreted High phosphate levels > 'drag' calcium from the bones

What are options for renal replacement therapy (RRT)?

Haemodialysis Peritoneal dialysis Renal transplant

When is dialysis started in CKD?

When eGFR <15mL/min

Risks/complications of haemodialysis?

Hypotension, air embolus, site infx, endocarditis

Risks/complications of peritoneal dialysis (4)?

Peritonitis, catheter infx/blockage, fluid retention, hernias

Risks/complications of renal transplant?

Rejection, PE/DVT, BM suppression, malignancies, recurrence of dx

What are some causes of increased aldosterone activity (5)?

Liver cirrhosis Heart failure Loop diuretics Thiazide diuretics Conn's syndrome (hyperaldosteronism)

What is nephrotic syndrome?

Inflamed basement membrane in glomerulus > permeable > loss of proteins

What is the clinical triad in nephrotic syndrome?

Proteinuria Hypoalbuminaemia Oedema

What are some other features of nephrotic syndrome (outside of classic triad) (5)?

Peripheral/periorbital oedema Hyperlipidaemia Pleural effusion Hypercoagulability Infections

What are some primary causes of nephrotic disease (3)?

Minimal change disease Focal segmental glomerulonephritis Membranous glomerulonephritis

What are some secondary causes of nephrotic disease (7)?

Diabetic nephropathy SLE HSP Infections Drugs Myeloma Pre-eclampsia

Investigations in suspected nephrotic syndrome (4)?

Urine dipstick Urine MCS Bloods: U&Es, Cr, albumin, FBC, ESR/CRP, LFTs Renal biopsy

Management of nephrotic syndrome?

Tx - High-dose steroids Reduce oedema - loop diuretics, fluid and salt restriction Reduce proteinuria - ACEis/ARBs

What are some possible complications of nephrotic disease (3)?

Thromboembolism Infection Hypovolaemia

What is nephritic syndrome?

Generic term for inflammation in the kidneys

What is the clinical triad in nephritic syndrome?

Haematuria Oliguria Proteinuria

What are some causes of nephritic syndrome (4) ?

IgA nephropathy Post-strep Goodpasture's disease Membranous nephropathy Membranoproliferative

Classic IgA nephropathy presentation?

1-2 days after URTI Haematuria Young male

Class post-streptococcal glomerulonephritis presentation (3)?

1-2 **weeks** after URTI Haematuria Low complement

Management of IgA/Post-streptococcal glomerulonephritis?

ACEi/ARB +/- corticosteroids

How do IgA/post-strep cause glomerulonephritis?

Immune complex deposits Activate complement and inflammation

How does goodpasture's disease cause nephritic syndrome?

Anti-GBM antibodies

Management of goodpasture's nephrotic syndrome?

Plasmapheresis (to remove abs) Steroids Cyclophosphamide

What features (other than nephritis) may be seen in goodpasture's disease (2)?

Haemoptysis Alveolar haemorrhage

What are some causes of pseudohaematuria (red urine without bleeding)?

Beetroot Rifampicin Bilirubin Myoglobin

What are some possible causes of haematuria?

UTI Stones Malignancy BPH Glomerulonephritis Trauma

Triad of cardiorenal syndrome?

Decreased kidney func Therap-resistant HF w/ congestion Worsening kidney function during HF therapy

What are some possible causes of rhabdomyolysis (6)?

Long lie after fall - most common Seizure MDMA Crush injury Statins Extremely vigorous exercise (beyond person's fitness level)

What electrolyte disturbances occur in rhabdomyolysis?

Hyperkalaemia

Signs and symptoms of rhabdomyolysis?

Red-brown urine Reduced urine output Muscle pain/weakness Muscle welling Featigue N+V Confusion

What is the cause of urine discolouration in rhabdomyolysis?

Myoglobinuria - red-brown urine

Investigations and findings in suspected rhabdomyolysis?

U&E/GFr = AKI and ↑K+ CK = disproportionately raised to AKI

Management of rhabdomyolysis?

IV fluids Maintain good urine output IV sodium bicarbonate occasionally used

Why does anaemia commonly develop in CKD?

Due to ↓erythropoietin levels (EPO)

What kind of anaemia occurs due to CKD?

Normochromic normocytic anaemia

What is the screening investigation for relatives of those with autosomal dominant polycystic kidney disease?

Abdo USS

When do the different polycystic kidney diseases present?

ADPKD = adulthood ARPKD = childhood

Which polycystic kidney disease is more common?

Autosomal dominant

Clinical features of ADPKD (5)?

HTN Recurrent UTIs Flank pain Haematuria Palpable kidneys

What are some extra-renal manifestations in ADPKD (4)?

Liver cysts Berry aneurysms Mitral regurgitation Diverticula in colon

What drug may be given in ADPKD?

Tolvaptan to slow progression of cyst development and renal failure

Management options for ADPKD (6)?

Antihypertensives Drainage Dialysis Renal transplant Analgesia Abx for infx

Which conditions may cause a **raised anion gap** metabolic acidosis?

ACIDIC THINGS Lactate = shock, hypoxia Ketones = DKA, alcohol Urate = renal failure Acid poisining = salicylates, methanol

IgA nephropathy vs post-strep glomerulonephritis presentation?

IgA = 1-2 days after illness Post-strep = 1-2 weeks after illness

Possible causes of acute interstitial nephritis?

Drugs Systemic disease (SLE, sjogren's) Infection

Which drugs may cause interstitial nephritis (5)?

NSAIDs Furosemide PPI Penicillins Allopurinol

Features of acute interstitial nephritis (6)?

Fever Rash Arthralgia Eosinophilia Mild renal impairment HTN

Possible causes of urinary retention?

Obstruction - stone, malignancy, constipation, stritures Meds Neurological causes

Symptoms of acute urinary retention (4)?

Inability to pass urine Suprapubic/lower abdo discomfort Pain/distress Confusional state (elderly)

Investigations in acute urinary retention?

Urine dip/analysis (may be after catheter) U&Es FBC CRP Bladder USS

Which drugs may cause urinary retention?

TCAs Anticholinergics Opioids NSAIDs

Possible mechanisms in renal tubular acidosis (2)?

Decreased acid urine Decreased HCO3 reabsorption

What drug is contraindicated in renal artery stenosis?

ACE inhibitors

On bloods, what may indicate dehydration is the cause of an AKI?

Urea:creatinine ratio >100 (Urea higher)

How to calculate anion gap?

(sodium + potassium) - (bicarbonate + chloride)

What is normal anion gap?

8-14 mmol/L

Which drugs can cause acute interstitial nephritis?

Penicillin NSAIDs Rifampicin Allopurinol

Why is there increased VTE risk in nephrotic syndrome?

Loss of anti-thrombin III

Renal Flashcards

(87 cards)