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15 Cards in this Set
- Front
- Back
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Define acute kidney injury |
Acute reduction of renal function with morphologic tubular injury |
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What are the causes of AKI |
Pre-renal: hypovolaemia - ischaemia Renal: local ischaemia - systemic thrombosis (HUS/DIC/TTP) Direct toxic injury to tubules - drugs/contrast Acute tubulointerstitial nephritis Post renal: obstruction - stones, tumour |
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Describe the typical clinical course of AKI |
Initiation: decr urine output w/ elevation urea - 36hrs Maintenance: oliguria, salt/H2O overlad, incr urea/K/H (uraemia, hyperkalaemia, acidosis) Recover: incr urine vol (up to 3L/d), H2O/Na/K loss, Ur/Cr normal - polyuric |
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What are the manifestations of the nephrotic syndrome? |
Generalised oedema Proteinuria Hypalbuminaemia Hyperlipidaemia/lipiduria 3/4 pass |
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What are the mechanisms of the oedema? |
Decreased plasma osmotic pressure - loss serum albumin Accumulation Na and H2O in tissues Compensatory secretion Aldostrone secondary to hypovolaemia, increased ADH + SNS (increased hydrostatic/lymph) |
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What are the causes of urinary tract obstruction? |
Intrinsic: - Congenital abnormalities, urethral strictures, uretopelvic narrowing, reflux - Calculi - Tumours - Inflammation: prostatitis/urethritis/ureteritis - Thrombosis/embolism - Sloughed papillae Extrinsic: - tumours -BPD - Pregnancy - Functional disorders, neurogenic bladder |
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What are the clinical features of acute obstruction |
Asymptomatic Pain Decreased urine output/retention oliguria/anuria hyperkalaemia/renal failure |
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What are the possible clinical sequelae of urinary tract obstruction? |
Resolve Infection Stone formation Renal failure Hydronephrosis, obstructive uropathy 3/5 |
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Describe the progression of effects of unrelieved obstruction of a ureter |
Hydronephrosis (prox dilation of ureter) w/ reduced GFR Renal parenchymal atrophy Interstitial inflammation leads to fibrosis Enlargement of kidney Eventually results in large thin walled non-functional cystic structure To pass: need dilation, parenchymal atrophy and loss of function |
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What are the main types of renal calculi? |
Calcium oxalate/phosphate 70% Struvite stones: calcium, Mg, Phosphate stones 15 - 20% Uric acid stones 5 - 10% Cysteine 1 - 2% Ca and 1 other to pass |
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What conditions in urine favour stone formation |
Changes in urine pH Changes in urine volume Bacteria Increased concentration of stone constituents 2 to pass |
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What are the complications of ureteric calculi? |
Pain Haematuria Infection Obstruction - hydronephrosis Renal impairment 1 bold and 1 other |
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What organisms cause acute pyelonephritirs? |
Gram -ve bacilli (> 85%) E. Coli Proteus Klebsiella Enterobacter Other staph, fungi Bold and 3 others to pass |
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What steps are involved in ascending infection? |
5 steps 1. Colonisation distal urethra 2. Entry into bladder 3. Stasis/urinary tract obstruction 4. Vesicoureteric reflux 5. Intrarenal reflux |
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What are the features of chronic pyelonephritis? |
Chronic reflux/obstruction causes pelvocalyceal damage Recurrent infections lead to recurrent bouts of renal inflammation and scarring Bold and concept |
