Flashcards
MBBS III Summative WCS Nephro
Cards in this deck (30)
- 1K/DOQI classification of CKD5 stages:
1. kidney damage with normal GFR
2. mild reduction in GFR
3. moderate
4. severe
5. kidney failure
*normal GFR = 100-125ml/min/1.73m2 - 2Pitfalls of using serum creatinine to reflect renal function- only starts to increase when GFR < 50%
- affected by muscle mass, tubular secretion
- overestimate GFR in severe renal impairment
- potential drug interactions: increase serum level - 3Pitfalls in using serum urea to reflect renal function- affected by hydration status, GI bleed, use of steroids
- underestimate GFR by tubular reabsorption - 4Important Hx in CRF- PMH: DM, HT, autoimmune dx esp SLE, calculi
- Fhx: PCKD, GN, those who are on dialysis
- Drugs, recent contrast study - 5Clinical features of CRF1. general: anorexia, malaise, pruritus, nausea, vomiting
2. urinary: polyuria, nocturia --> oliguria
3. CVS: cardiomegaly, pul edema, ankle edema, hypertension, uraemic pericarditis
4. CNS: hiccups, restless legs, uraemic encephalopathy
5. hemat: NcNc anemia, bleeding tendency
6. endo: hyperparathyroidism, infertility, amenorrhoea, sexual dysfunction, renal osteodystrophy, GR in children
7. metabolic: hypoNa, hyperK, hypoCa, hyperP, acidosis - 6Ix for CRF- CBC (NcNc anemia!), RFT, bone profile, PTH
- immune markers, Ig level
- blood glucose, lipids
- urinalysis for RBC, casts, protein
- 24 hr urine P/C ratio
- USS
- biopsy if needed - 7Mx of CRF1. general renoprotective measures:
- control BP, proteinuria, fluid overload
2. treatment of underlying dx
3. treatment of Cx: hyperkalemia, hyperphosphatemia, acidosis, hyperparathyroid, anemia
4. prepare for RRT: preserve vascular access, counseling, contact donor - 8GN presentation- asymptomatic with microscopic hematuria/proteinuria
- macroscopic hematuria
- acute nephritic syndrome
- nephrotic syndrome
- RPGN
- chronic GN - 9Ddx of macroscopic hematuria- urological: stone, tumor, prostate
- renal: GN, acute interstitial nephritis, PCKD
- infection: TB, UTI, schistosomiasis
GN causes:
- IgAN
- Alport's syndrome
- thin membrane dx (= familial benign hematuria) - 10Hx taking in hematuria- confirm true hematuria (transient vigorous exercise)
- flank pain radiating to groin
- LUTS
- dysuria/fever
- Fhx
- URTI/GE
- bleeding tendency
- drugs e.g. anticoagulants - 11Ix for hematuria- RFT
- urinalysis: microscopy, culture, AFB, RBC, casts, cytology
- KUB
- USG - 12urinary dipstick- negative: <10mg
- trace: 15-30
- 1+: 30-100
- 2+: 100-300
- 3+: 300-1000
- 4+: >1000 - 13pitfalls in proteinuria assessment- strenuous exercise within 24 hrs
- concomitant systemic infection
- UTI
- Fever
- Pregnancy
- marked HT
- hematuria - 14acute nephritic syndrome criteria1. haematuria
2. acute renal failure
3. hypertension + edema (fluid retention)
4. urine protein <3g/d
e.g. poststreptococcal GN - 15Poststreptococcal GN Ix- low C3
- antibody to streptolysin O raised
- should resolve within 1-2 weeks, persistent low C3 >8 weeks raise possibilities of lupusN or MPGN - 16nephrotic syndrome criteria- proteinuria >3.5g/d
- edema
- hyperlipidemia, lipiduria
- hypoalbuminemia - 17causes of nephrotic syndromeprimary:
- membranous glomerulopathy
- minimal-change disease
- focal segmental glomerulosclerosis
- IgA nephropathy
- MPGN
secondary:
- DM
- SLE
- amyloidosis
- secondary membranous - 18secondary membranous glomerulopathy causes- infection: HBV, HCV, HIV, malaria, syphilis
- malignancy: lymphoma, MM, adenocarcinoma of lung, GI and breast
- drugs: penicillamine, gold, mercury, NSAIDs, probenecid - 19Ix for nephrotic syndrome- CBC, RFT
- urinalysis, 24-hour urine protein
- Ig pattern
- autoimmune markers e.g. ANCA, ANA, anti-dsDNA, C3/4, CRP
- fasting glucose
- HBsAg, anti-HCV/HIV
- tumor screening: tumor markers, CXR, stool OB
- USG kidney+/-renal biopsy - 20RPGN criteria- signs of GN: proteinuria, haematuria, red cell casts
- rapidly declining renal fx within days to weeks
- cellular crescents - 21RPGN causes- pauci-immune GN (systemic vasculitis)
- anti-GBM/Goodpasture
- crescentic IgAN
- acute post-infectious GN
- cryoglobulinemia
- SLE - 22Ix for RPGN- CBC, RFT
- urinalysis, microscopy
- 24 hour urine protein
- autoimmune markers: ANA, anti-dsDNA, anti-GBM, ANCA, C3/4, CRP
- CXR, DLCO
- CT thorax
- bronchoscopy - 23ARF etiology1. prerenal: azotemia, HRS, cardiac failure
2. renal arteries: RAS, large/medium vasculitis
3. small vessels dx
4. glom dx
5. ATN: contrast, ischemia
6. AIN: drugs, infection
7. intratubular obs: cast in MM, drugs
8. postrenal obs: tumor, stone, prostate
9. renal vein: thrombosis - 24Cx of peritoneal dialysis- exit site infection
- peritonitis
- malfunction/malposition
- ultra-filtration failure
- anastomotic leakage --> pleural effusion - 25vascular access- arteriovenous fistula
- arteriovenous graft
- double-lumen central venous catheter: tunnel-cuffed and non-cuffed - 26Cx in hemodialysis- Vascular access: stenosis, thrombosis, upper limb ischemia
- Catheter access: exit site infection, tunnel track infection, bacteremia, malfunction
- CVS: hypotension, arrhythmia
- Neuromuscular: muscle cramps
- Air embolism, blood loss - 27Immunosuppressants in graft kidney recipients1. prednisolone
2. calcineurin A inhibitors: cyclosporine A, tacrolimus
3. azathioprine OR MMF OR mTOR inhibitors e.g. sirolimus, everolimus - 28Long term Cx in renal graft- infection
- malignancy
- CVS due to DM/HT/hyperlipidemia caused by drugs
- chronic allograft injury
- immunosuppressants SE
- recurrence of primary disease - 29CI for renal biopsy- bleeding diathesis e.g. aspirin
- small kidneys
- only 1 solitary kidney - 30Toxicity of various immunosuppressive drugs- cyclosporine A (a calcineurin inhibitor): nephrotoxicity, gingival hyperplasia, hypertrichosis, hyperlipidemia, hypertension, lymphoproliferative disorder
- azathioprine: dose-related myelosuppression, alopecia, hepatitis
- methotrexate: pulmonary and hepatic fibrosis, intestinal upset, myelosuppression, NOT nephrotoxic, teratogenic
- allopurinal: nephrotoxic, hypersensitivity: DRESS syndrome (drug rash with eosinophilia and systemic sx) e.g. toxic epidermal necrolysis, erythema multiforme, both are variant forms of Steven-Johnson syndrome
*ALL: immunosuppression*
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- Flashcards on MBBS III Summative WCS Nephro, created by pris_0727 on 20/04/2014.
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