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Renal (AKI (Pre-renal (Hypovolaemia (sepsis), haemorrhage, dehydration),…
Renal
AKI
Pre-renal
Hypovolaemia (sepsis), haemorrhage, dehydration
Renal
GN, AlN (allergy, eosinophilia, rash), toxins (ACEi, NSAIDs, gent)
Post renal
Obstruction (malignant, stone, bladder outflow abs)
Get CR rise from baseline and hyperK
Drugs to
stop
: ACEi, ARB, NSAIDs (constrict afferent arteriole), Aminoglycosides, K+ sparing diuretics
Drugs to
alter or reduce
: Opiate analgesia, metformin (risk of lactic acidosis), diuretics, sublet heparin, amino glycosides, amphotericin B, lithium
See metabolic acidosis as H+ can't be excreted
Hyperparathyroidism
Primary: Solitary adenoma
high Ca, low PO4
, high PTH - often present on routine tests
Secondary: CKD, diet (no Vit D)
HIGH PO4, low Ca
, high PTH
Tertiary: Prolonged CKD
High PO4 and Ca
Bones, stones, moans (abdominal), thrones, psychiatric groans, can get long QT = arrhythmias
PTH increases osteoclast activity
Rx: Fluid + bisphos
Diuretics
(Ascending) Loop: Furosemide, bumetanide - HF, HTN, hyper cal
DCT (Na-Cl sym) - Thiazide (Bendroflumethiazide)
K sparing - 1) Amiloride - DCT Na channes 2) Spiro DCT - aldo agonist
PCT - Carbonic anhydrase - acetazolamise to inc HCO3 exc
Renal Transplant
Hyperacute: Mins-hrs, rare & due to HLA mismatch
Acute: <6months, T cell mediates, CMV, can be reversible with immune suppression
Chronic: >6 months, antibody mediated, can be due to occuarance of original disease
Post-Op: Urine leak, PAS, renal vascular thrombosis (suddenly no urine output), infection (CMV, HSV, Canada), malign, CVS disease
Bones diseases
Osteoporosis - weak bones, low bone mineral density, long term steroid use, vit D deficiency, low body weight
Normal biochemistry
Osteomalacia: Poor bone mineralisation, low vit D intake
Low Ca, low PO4
Pagets: Increased bone turnover, high output HF, deafness, bowing of long bones
Isolated high ALP, high Ca fracture
Nephritic - get HTN
Rapidly progressive (good pastures (pul+renal), ANCA +ve vasculitis), IgA* (days after URTI), laporte, membroprolif GN, diffuse GN, post-strep (weeks after URTI)
*Henoch-Schonlein Purpura - systemic variant of IgA, purpuric rash on extensors inc buttocks and legs, abdominal pain, nephrotic
HTN is compensatory due to damage to glomerulus restricts blood flow and causes mod/sever decreased eGFT - leads to RAAS activation and HTN
ACEi
Dilate the efferent arteriole of the glomerulus; SE: Bradykinin cough;
30% rise
in creatinine acceptable, startled and titrate up, careful of renal artery stenosis
Renal artery stenosis: Causes serious injury when ACEi started because of loss of efferent vasodilator
Stones
Calcium oxalate most common; RF: HyperPTH, Crohn's (fat bind Ca leaving oxalate free to be deposited in kidneys), hyper cal, ethylene glycol poisoning
Urate stones aren't radiolucent - suspect in flint pain + temp + normal XR; RF: Gout, ileostomy (loss of bicarb and fluids caused acidic urine)
Infection
LUTI: Tri warfarin interaction)/nitro
Pyelonephritis: Co-amox 14 days
Nephrotic syndrome
Minimal change (give steroids), membranous (infection, rheum drugs, malignant), membroproliferative (hep B/C, cryoglob), FSG (heroin, HIV), diabetic, amyloidosis, SLE
Complications
Infection: Due to decreased protein (inc IgG, T cells complement etc
Hypercoaguable: Due to decreases Anti-throbin II, protein C/S -> higher risk of DVT/PE
Hyperlipidaemia: Liver released TAGs due to decreased oncotic pressure
Acute Renal Failure
Renal ischaemia, vasculitis, connective tissue disease, drug therapies(gent/cephalosporin), infection
Ischaemia typically causes acute tubular necrosis
CKD
Aim for BP of 130/80 in CKD pts; 125/75 in DM
Granulomatosis with polyangitis
Autoimmune vasculitis affects
resp & kidneys
, saddle shaped nose deformity,
cANCA
, give steroids and immunosuppression
Indications fo emergency dialysis
Hyperkalaemia, uraemia pericarditis, severe acidosis, pulmonary oedema
Haemolytic uraemia syndrome: anaemia, renal failure, thrombocytopenia - fluids