Loop diuretic Works on NKCC2 transporter in ascending limb OUT: - Sodium - Potassium - Chloride - Water Side effects - Postural hypotension - HYPOkalaemia - HYPOnatraemia - HYPOchloraemia - HYPOcalcaemia

Works on DCT Blocks Na+/Cl- symporter Side effects - Postural hypotension - HYPOkalaemia - HYPOnatraemia - Gout

Aldosterone antagonist Potassium sparing DCT and collecting duct Blocks aldosterone OUT - Sodium - Chloride IN - Potassium Side effects - Postural hypotension - HYPERkalaemia - Metabolic acidosis - AKI

HIGH urinary sodium Urine dip = Protein +++ Acute tubular necrosis - Most common - Due to sepsis Acute interstitial nephritis - White cells on urine dip Glomerulonephritis Sepsis HUS Rhabdomyolysis

Obstruction - Stones - Strictures - BPH - Cancer - Surrounding masses

Pre-renal - NSAIDs - ACE-I Renal - Penicillin - Cephalosporins - Gentamicin Post-renal - Acetylcholine

Asymptomatic ``` Oliguria Arrhythmias Confusion Seizures Fluid overload - Oedema ``` Uraemia - Vomiting - Dizziness - Cognitive impairment - Asterixis

Renal Flashcards by Jack Hogg

Kidney functions and measuring renal function

Removal of waste products
Vitamin D activation
Regulate pH
Regulate water
EPO production

Measuring renal function

eGFR
U&E - Creatinine, creatinine clearance, urea
Catheter
Calcium
Urine dip
Albumin:Creatinine ratio - CKD staging

How well did you know this?

Not at all

Perfectly

Furosemide

Loop diuretic

Works on NKCC2 transporter in ascending limb

OUT:

Sodium
Potassium
Chloride
Water

Side effects

Postural hypotension
HYPOkalaemia
HYPOnatraemia
HYPOchloraemia
HYPOcalcaemia

How well did you know this?

Not at all

Perfectly

Bendroflumethiazide

Works on DCT
Blocks Na+/Cl- symporter

Side effects

Postural hypotension
HYPOkalaemia
HYPOnatraemia
Gout

How well did you know this?

Not at all

Perfectly

Spironolactone

Aldosterone antagonist
Potassium sparing

DCT and collecting duct
Blocks aldosterone

OUT

Sodium
Chloride

IN - Potassium

Side effects

Postural hypotension
HYPERkalaemia
Metabolic acidosis
AKI

How well did you know this?

Not at all

Perfectly

Pre-renal AKI

LOW urinary sodium

Hypotension
Dehydration
Haemorrhage

Sepsis
HF
Renal artery stenosis

How well did you know this?

Not at all

Perfectly

Renal AKI

HIGH urinary sodium
Urine dip = Protein +++

Acute tubular necrosis

Most common
Due to sepsis

Acute interstitial nephritis - White cells on urine dip
Glomerulonephritis

Sepsis
HUS
Rhabdomyolysis

How well did you know this?

Not at all

Perfectly

Post-renal AKI

Obstruction

Stones
Strictures
BPH
Cancer
Surrounding masses

How well did you know this?

Not at all

Perfectly

Nephrotoxic drugs

Pre-renal

NSAIDs
ACE-I

Renal

Penicillin
Cephalosporins
Gentamicin

Post-renal - Acetylcholine

How well did you know this?

Not at all

Perfectly

AKI risk factors and definition

Age
Dehydration
Nephrotoxic drugs
Contrast
Underlying renal disease 
Diabetes

< 0.5 ml/kg for 6 hours
Creatinine ^ 50% in 7 days

Grading

1.5-1.9x baseline
2-2.9x baseline
3x baseline

eGFR decrease by 25% in 7 days

How well did you know this?

Not at all

Perfectly

AKI presentation

Asymptomatic

Oliguria
Arrhythmias
Confusion
Seizures
Fluid overload - Oedema

Uraemia

Vomiting
Dizziness
Cognitive impairment
Asterixis

How well did you know this?

Not at all

Perfectly

AKI investigations and management

Urine dip / MC&S
U&E - Urea:Creatinine ratio
Septic screen
USS within 24 hours if cause unknown

Management - Treat cause!

IV fluids
Stop nephrotoxic drugs
Change drugs that are renally excreted - May cause toxicity
Treat metabolic acidosis - Sodium bicarbonate
Catheter

Treat hyperkalaemia - Calcium gluconate

If K > 6.5 or ECG changes
Risk of tissue necrosis

How well did you know this?

Not at all

Perfectly

HYPERkalaemia aetiology and presentation

Rhabdomyolysis
AKI / CKD
DKA
Addison's
Tumour lysis syndrome

Drugs

Spironolactone
ACE-I
A2RB
Heparin

Presentation

Weakness
Flaccid paralysis
Decreased reflexes

How well did you know this?

Not at all

Perfectly

HYPERkalaemia investigations and management

Investigations

U&E
ECG - TTT - Tall Tented T waves

Management - C BIG K Drop

Calcium gluconate (If ECG changes or K > 6.5)
Bicarbonate - Sodium bicarb
Insulin
Glucose - Dextrose
K+ reduction - Salbutamol
Dialysis

How well did you know this?

Not at all

Perfectly

HYPOkalaemia aetiology and presentation

Diarrhoea
Vomiting
Conn’s

DKA treatment - Salbutamol

Drugs

Furosemide
Thiazides

Presentation

Weakness
Hypotonia
Muscle pain

How well did you know this?

Not at all

Perfectly

HYPOkalaemia investigations and management

U&E

ECG

Inverted T waves
ST depression
Prolonged PR
U waves

Management - KCl - Sando-K

How well did you know this?

Not at all

Perfectly

Pyelonephritis

Study These Flashcards

E.Coli
Klebsiella
Pseudomonas
Proteus

Presentation

Fever
Rigors
Flank pain
N/V
Lower UTI symptoms
Sepsis

Investigations - Sepsis 6!

USS/CT for abnormalities or stones
Urine dip / MC&S

Management

Abx - Cipro
Severe - IV Cef

PKD

Study These Flashcards

ARPKD - 16,4
ADPKD - 6

Presentation

Renal symptoms
Abdo mass - Flank
Flank pain
Recurrent UTIs
Haematuria
Stones

Associated conditions

HTN
SAH
Mitral valve prolapse
Liver cysts

Investigations

USS - Multiple cysts on kidneys
Screen for SAH

Management

Treat HTN
Family screening

Renal cancer

Study These Flashcards

Smoking
Von-Hippel Lindau disease

Clear cell carcinoma - Most common
Transitional cell carcinoma

Presentation

Painless haematuria
Loin pain
Abdo mass
- Weight loss
- Left varicocoele - LTV drains into LRV
- Hepatosplenomegaly
- Mets - Lung (cannonball mets) / Bone

Investigations

Urine dip / MC&S
CT + Biopsy
CXR - Cannonball mets

Management

Partial / Total nephrectomy
Chemo/Radio

Haematuria aetiology

Study These Flashcards

Vascular - Coagulopathy
Iatrogenic - Radiotherapy / Catheter
Trauma - Lacerations
Autoimmune - SLE / RA

Infection

LUTI
Pyelonephritis
TB

Neoplasm

Nephroblastoma - Children - Flank mass
Renal cell carcinoma - Painless of painful haematuria
Bladder cancer - Painless haematuria
Prostate cancer / BPH

Drugs - Penicillin / NSAIDs

Other

Stones
Structural abnormalities
Gynae - Endometriosis
Renal disease - Glomerulonephritis

Haemolytic uraemic syndrome

Study These Flashcards

E.Coli O157:H7
“Kid went to a farm”

Presentation

AKI
Thrombocytopenia
Microangiopathic haemolytic anaemia
- Gastroenteritis

Investigations

Urine dip - Haematuria
Stool sample
AKI work up
FBC - Thrombocytopenia + Haemolytic anaemia

Management - Supportive

Nephrotic syndrome aetiology and presentation

Study These Flashcards

Children - Minimal change disease
FSGS
Membranous nephropathy

Cytokine mediated damage to GBM
^ Glomerular permeability

Presentation

Oedema
Proteinuria
Hypoalbuminaemia

Nephrotic syndrome investigations / management / complications

Study These Flashcards

Urine dip - Proteinuria
MSU-MCS
ACR 
FBC
Clotting
Renal biopsy

SLE antibodies

Management

Chidren / Steroid sensitive - Prednisolone
Adults / Steroid-resistant - Cyclophosphamide

Complications

Infections due to loss of IgG
Thrombophilia
Hypercholesterolaemia
AKI
HTN

Nephritic syndrome

Study These Flashcards

IgA nephropathy
Goodpasture's
Wegener's
PSGN
SLE

Presentation

AKI
HTN
Haematuria

Investigations

Urine dip - Haematuria
Urinalysis - RBC casts
ASO titre
ANA
ANCA
Anti-dsDNA

Management - Supportive

Low salt
IV Prednisolone
Diuretics

ACE-I side effects

Study These Flashcards

Hyperkalaemia
Renal impairment
Dry cough - Bradykinin
Postural hypotension

CKD aetiology

Age DM PKD Heart disease Myeloma Interstitial disease - TB Glomerular disease Smoking Nephrotoxics - NSAIDs, etc.

CKD complications

Malaise Uraemia - Itching Restless leg syndrome Amenorrhoea ED Anaemia Electrolyte imbalance Osteoporosis

CKD investigations / findings

Bloods - Anaemia - ESR ^ - Myeloma? - Glucose ^ - DM? - Hyponatraemia - Hyperkalaemia Urine - Proteinuria - Haematuria Other - Renal USS - CT

CKD staging and management

1. > 90 2. 60-90 3a. 45-60 3b. 30-45 4. 15-30 5. < 15 Management - Control HTN - Control DM - Prevent CVD - Correct anaemia - Treat electrolyte imbalance - RRT

Dialysis indications

Dialysis is AA PUMP (It's not, but oh well) Arrhythmias AKI/CKD Potassium ^^^^^ Uraemia Metabolic acidosis Pulmonary oedema

Dialysis types

Haemodialysis - Blood passed over semi-permeable membrane against dialysis fluid - Requires anticoagulation - Requires AV fistula - Hospital or home treatment - Complications - Infection, hypotension, N/V Peritoneal dialysis - Peritoneum used as semi-permeable membrane - CI in obesity or intestinal disease - Good for young independent patients - Complications - Peritonitis, hernia

Renal transplant

Matching - ABO - HLA - Antibody Advantages - Prolongs life - Prevents complications - Anaemia Risks - Operative risk - Infection - Cancer risk - Due to immunosuppression - Rejection risk

Renal transplant rejection types

Hyperacute - Minutes Wrong ABO Accelerated - Days - T-cell mediated Acute cellular - 3 weeks - Steroids Chronic - Years - Fibrosis

Renal Flashcards

(32 cards)