06 METABOLIC MEDICINE 08 INFECTIOUS DISEASE 08.06 Antibiotics – mechanisms of 09 DERMATOLOGY 09.06 Dermatological infections
& ENDOCRINOLOGY action and side effects • Tinea / dermatophyte infections
08.01 Bacterial infections • Notifiable diseases 09.01 Dermatological emergencies • Candida • Viral warts
06.01 Thyroid • Anthrax • Bacillus cereus • Acute urticaria & angioedema • Molluscum contagiosum
• Hypothyroidism • Hyperthyroidism • Campylobacter • Botulism 08.06 Viral infections • Steven-Johnson's & TEN
• Thyroid cancers • Goitre • Cat scratch disease • Cholera • Chikungunya • Covid-19 • Eczema herpeticum 09.07 Dermatological infections
• Clostridiodes difficile • Diphtheria • Cytomegalovirus • Epstein-Barr • Staph scalded skin syndrome • Varicella / chickenpox
06.02 Adrenals • Escherichia coli • HFMD • HSV • Necrotising fasciitis • Herpes zoster / shingles
• Cushing's disease • Enteric fever (typhoid/paratyphoid) • Japanese encephalitis • HIV • Pityriasis rosea
• Adrenal insufficiency 09.02 Melanocytic lesions and mimickers • Hidradenitis suppurativa
• Hyperaldosteronism 08.02 Bacterial infections 08.07 Viral infections • Melanoma & differentials
• Phaeochromocytoma • H. influenzae • Klebsiella • Influenza • Measles • Seborrhoeic keratosis • Benign naevi 09.08 Miscellaneous
• Leptospirosis • Leprosy • Mpox • Orf • Mumps • Dermatofibroma • Pemphigus • Bullous pemphigoid
06.03 • Listeria • Lyme disease • Norovirus • Parvovirus • Pyoderma gangrenosum • Insect bites • Skin lesions
• Acromegaly • Prolactinoma • Meliodosis & other Burholderia • Poliovirus
• Hyperthyroidism & hypoparathyroidism • Mycoplasma pneumoniae 09.03 • Non-melanoma skin cancers 10.07 Platelet disorders
• Immune thrombocytopaenia
• Multiple endocrine neoplasia • Pseudomonas aeruginosa 08.09 Viral infections - BCC & SCC
• Thrombocytopaenia
• Salmonella • Shigella • Rabies • RSV • Rotavirus • Acne vulgaris
• Haemophilia
06.04 Diabetes melitus • Rubella • West Nile • Zika
• von Willebrand disease
• T1DM, T2DM 08.03 Bacterial infections • Viral haemorrhagic fevers, including 09.04 • Eczema • Psoriasis
© quackquackmed.com
• Neutropaenia
• Drugs used in DM • Insulin • Q fever • Staph. aureus Dengue, Ebola, Yellow Fever • Rosacea
• DVLA rules for diabetes • Coagulase-negative staphylococci
10.08 Blood products
• Complications of DM & sick day rules • Strep. pneumoniae 08.10 Genitourinary infections / STIs 09.05 Dermatological infections
• Packed red cells • Platelets
• Strep. pyogenes (incl scarlet fever) • Chlamydia • Gonorrhoea • Impetigo • Folliculitis
• CMV-ve and irradiated blood
06.05 • Strep agalactiae (GBS) • Bacterial vaginosis • Cellulitis & erysipelas
• FFP & cryoprecipitate
• Diabetic ketoacidosis • Tetanus & other Clostridia • Trichomonas vaginalis • Head lice • Scabies
• Hyperosmotic hyperglycaemic state • Yersinia pestis • Genital herpes • Genital warts • Prothrombin complex
• Cell saver devices
• Hypoglycaemia • Pubic lice • Donovanosis
10 HAEMATOLOGY & ONCOLOGY • Warfarin – Mx of high INR
• Diabetes insipidus 08.04 Bacterial & fungal infections • Syphilis • Chancroid
• Blood product transfusion
- Water deprivation test • Rickettsiae • Actinomyces & Nocardia • Ulcers in STIs
• Candida • Cryptococcosis 10.01 Haematological cancers complications, including TACO, TRALI
06.06 • Acid-base balance • Aspergillus • Mucormycosis 08.11 Helminth infections • ALL • CLL • Hairy cell leukaemia
• Hypercholesterolaemia • AML • CML • Myelofibrosis 10.09 Miscellaneous
• Histoplasmosis Incl Hookworm, Cutaneous larva
migrans, Strongyloides, Pinworm, • Myelodysplastic syndrome • Hereditary angioedema
• Polycythaemia vera • Hyposplenism • Splenomegaly
06.07 • Hyperkalaemia & hypokalaemia 08.05 Antibiogram Hydatid disease, Schistomiasis
• Thymoma • Lymphadenopathy
• Hypercalcaemia & hypocalcaemia
10.02 Haematological cancers • Drugs – anticoagulants, antiplatelets,
• Hypomagnesaemia 08.12 Protozoan infections
• Non-Hodgkin's lymphoma tranexamic acid
• Malaria • Toxoplasmosis
06.08 • Hyponatraemia (DDx) • Cryptosporidiosis • Chagas disease • Hodgkin's lymphoma
- SIADH • Multiple myeloma 10.10 Emergencies, organ transplants
• Sleeping sickness • Leishmaniasis
• Hypernatraemia 07.04 Infections of the urinary tract • Neutropenic sepsis
• Giardiasis • Amoebiasis
• Infectious cystitis including UTI 10.03 Primary immunodeficiencies • Tumour lysis syndrome
• Pyelonephritis • Epididymitis 08.13 Misc infections • Neutrophilia / phagocytes • Graft versus host disease (GVHD)
07 RENAL MEDICINE & UROLOGY • Prostatitis • Balanoposthitis • Superior vena cava syndrome
• Sepsis • Animal & human bites • T-cell disorders, incl DiGeorge's
• B & T-cell disorders, incl SCID • Organ transplant & rejection
• Cellulitis • Lemierre's syndrome
07.01 • Acute kidney injury (AKI) 07.05 • Urinary tract stones • Acute intermittent porphyria
• Spinal epidural abscess
• Chronic kidney disease (CKD) • Benign prostatic hyperplasia 10.11
• Hyposplenism • Diabetic foot infxn
- Renal replacement therapy • Erectile dysfunction • Common cancers • Tumour markers
• Vaccination schedule 10.04 Anaemia
• DDx chart + iron studies interpretation • Genetic conditions predisposing to
07.02 Glomerulonephritides 07.06 • Microcytic anaemia cancer
04.14 Misc infections
• IgA nephropathy • FSGS • Urological cancers: renal cell • Prescribing for palliative / end of life
• Diarrhoea DDx • Gastroenteritis
• ANCA glomerulonephritis carcinoma, bladder Ca, prostate Ca care
• List of other infections found in book 10.05 Anaemia
• Membranous GN • Myeloma kidney • Misc urology: circumcision, vasectomy, • Normocytic anaemia ÷ non-haemolytic
• Membranoproliferative GN priapism 10.12 Breast
and haemolytic anaemia
• Breast Ca • Fibroadenoma
07.03 • Diabetic nephropathy 07.07 Testicular lumps • Fibrocystic breast changes
10.06 • Microcytic anaemia
• Lupus nephritis • Inguinal hernia • Hydrocele • Methaemoglobinaemia • Fat necrosis • Lipoma
• Acute interstitial nephritis • Varicocele • Epididymal cyst • Thrombophilia • Phyllodes tumour • Galactocele
• Acute tubular necrosis • Epididymo-orchitis • Mammary duct ectasia
• Antiphospholipid syndrome
• ADPKD • Bartter & Gitelman • Testicular torsion • Testicular tumour • Duct papilloma • Lump description
• Thrombocytosis
, Acute kidney injury AKI Chronic kidney disease CKD
D: acute decline in kidney function Ix: D: abnormal kidney structure or function Mx: CKD-related anaemia
According to KDIGO, defined as • Bloods: U&Es ≥3mo 1. Slow progression • Pathophysiology
• ↑SCr ≥26.5 µmol/L in 48h, or • Urinalysis (consider intrinsic cause if • Optimise DM control - CKD → ↓erythropoietin → ↓RBC
• ↑SCr ≥1.5x baseline in last 7d +ve blood & protein; consider infxn if By definition this includes pts who only have
• Optimise HTN control production ∴ anaemia
• UO <0.5 mL/kg/h for 6h +ve nitites, leukocytes)
one kidney (eg kidney donors)
☝🏻
- ACEI or ARB - CKD → ↓absorption of iron
Further ÷ according to stages
• UO (?pts ideally on catheter to ensure
A: • diabetic nephropathy
↳ can cause small ↓GFR (≤↓25% ok) - Causes a normochromic normocytic
1. ↑SCr ≥26.5 µmol/L, or
accurate measurements) - SGLT2 inhibitors - evidence of benefit anaemia (normal Hb, just fewer RBC)
• hypertension
↑SCr 1.5-1.9x baseline, or • Imaging: renal US if no identifiable
cause or if judged to be at risk of
• chronic glomerulonephritis in reducing progression; dapaglifozin
only for now
- Can lead to left ventricular
hypertrophy
UO <0.5 mL/kg/h for 6-12h
2. ↑SCr 2.0-2.9x baseline, or
urinary tract obstruction
• chronic pyelonephritis
✌🏻
- furosemide (esp when GFR ≤45 • Mx: target Hb 10-12 g/dL
• adult polycystic kidney disease
☝🏻
© quackquackmed.com
UO <0.5 mL/kg/h for ≥12h • (others) mL/min; also helps ↓K) - iron supplementation to optimise
3. ↑SCr ≥3x baseline, or Mx: "STOP AKI" • Tx glomerulonephritis iron levels
↑SCr ≥353.6 µmol/L, or Sepsis - screen & treat ÷ into 6 grades by GFR
2. ↓risk of complications
- if no improvement, offer EPO-
analogues (eg darbepoietin)
UO <0.3 mL/kg/h for ≥24h, or Toxins - identify and stop G1. GFR >90 mL/min with evidence of
UO = 0 (anuria) for ≥12h, or • Stop as the worsen renal function: • Exercise, wt loss, stop smoking - pts may need blood transfusions
kidney damage (eg histopathology,
Initiation of RRT, or NSAIDs (except baby aspirin), amino- • Dietary advice
on imaging, on lab findings)
glycosides, ACEI, ARBs, diuretics - control dietary sodium intake esp
In pts <18yo, eGFR <35 mL/min G2. 60-89 mL/min Renal replacement therapy (RRT)
• Stop as AKI ↑risk of toxicity: metformin, G3a. 45-59 mL/min
• Atorvastatin 20 mg for 1' prevention of
SCr = serum creatinine cardiovascular disease
lithium, digoxin G3b. 30-44 mL/min Haemodialysis
A ÷ pre, intrinsic, post renal causes Optimise vol status and BP G4. 15-29 mL/min • Pt is hooked up to machine which
• IV crystalloid 500 mL bolus over 15 min 3. Treat complications "cleans" the blood
• Pre-renal causes G5 (end stage). GFR <15
-❗️ hypovolaemia (eg dehydration, (caution in HF, cirrhosis, etc)
• Withhold antihypertensives ÷ by albumin to creatinine ratio (ACR)
• Mineral bone disease Mx
• Anaemia Mx
• Usually required 3x/week, each
session lasts 3-5h
shock, diarrhoea)
- renal artery stenosis • Pt may require inotropes ↳ albumin and creatinine measured in • Access routes: arteriovenous fistula,
Prevent harm urine. Albumin is not normally excreted 4. End stage renal disease graft or central venous catheter
• Intrinsic renal disorders
• Tx reversible causes (eg obstruction) in urine (∴ ↑ACR indicates severity) • Renal replacement therapy
- glomerulonephritis
• Tx life-threatening complications A1. ACR <3 mg/mmol • Renal transplant Peritoneal dialysis
- acute tubular necrosis →next pg
= normal or mildly increased • At ESRD, if pt does not receive RRT,
↳ 45% cases (eg 2/2 sepsis) • Modify doses of meds
A2. ACR 3-30 mg/mmol their average life expectancy is ~6mo
• Filtration occurs in pt's abdomen
• Requires insertion of PD catheter
- acute interstitial nephritis →next pg = moderately increased
Renal replacement therapy (RRT) (surgically), via which pt can insert
- rhabdomyolysis (eg fall + long lie)
"AEIOU" indications A3. >30 mg/mmol = severe Mineral bone disease and drain PD fluid
- tumour lysis syndrome
• Post-renal causes • Acidosis (pH <7.1) • Pathophysiology • Continuous ambulatory PD - each
Note: protein:creatinine ratio (PCR) is also
- kidney stones in ureter/bladder
• Electrolyte imbalance, eg K>6.5
used to monitor kidney function, but ACR is - CKD → ↓vit D activation → ↓Ca exchange lasts 30-40 min, and the
- benign prostatic hyperplasia
• Intoxication ("SLIME" - salicylates, preferred in diabetics - CKD → ↓excretion of PO4 dwell time of fluid is 4-8h. Pt can go
- external compression of ureter lithium, isopropanol, methanol, - ↑PO4 also causes bone degradation about normal activities while the
ethylene glycol) ± drug overdose S/smx: • asmx early on, picked up on (osteomalacia) dialysis solution is in their abdomen
• Overload ± pulmonary oedema routine bloods - 2ndary hyperparathyroidism [→06.03] • Automated PD - pt is hooked up to
R: ↑age, underlying kidney disease (eg • Uraemia (pericarditis, encephalopathy, • unspecific s/smx - lethargy, anorexia machine that fills and drains
• Normalise PO4 levels
- ↓PO4 in diet
diabetic nephropathy), hospitalisation for end organ failure) (wt loss), insomnia, NV abdomen overnight
various causes (15% inpatients develop • in later stage kidney failure, pts can - PO4 binders (eg sevelamer)
AKI), drugs (eg NSAIDs, amino-
glycosides, ACEIs, ARBs, diuretics)
Mx of hyperkalaemia develop anaemia, pruritus (2/2 uraemia) ↳ avoid calcium based binders as Renal transplant
• Kidney from live or deceased donor –
- Cardiac protection with IV calcium they can cause hyperCa and
chloride or calcium gluconate + ECG usually placed in the right or left iliac
vascular calcification
- IV insulin/glucose + salbutamol neb Ix: • bloods (U&Es) fossa and attached to external iliac
S/smx: • may be asmx until late • Normalise vit D levels
• Usually picked up on routine bloods or - (see notes on hyperkalaemia) • Urinalysis + ACR/PCR vessels
when ↓UO
• Imaging ± biopsy - Supplementation: alfacalcidol
• Normalise PTH levels
↳ native kidneys remain
• Pulmonary & peripheral oedema • Requires life long immuno-
- parathyroidectomy if severe
• Arrythmias 2/2 electrolyte disturbances suppression to prevent rejection
• Features of uraemia, eg encepha- • Lifespan of donor kidney is ~10-15y
lopathy, pericarditis
07.01 Renal & Urology – AKI & CKD
& ENDOCRINOLOGY action and side effects • Tinea / dermatophyte infections
08.01 Bacterial infections • Notifiable diseases 09.01 Dermatological emergencies • Candida • Viral warts
06.01 Thyroid • Anthrax • Bacillus cereus • Acute urticaria & angioedema • Molluscum contagiosum
• Hypothyroidism • Hyperthyroidism • Campylobacter • Botulism 08.06 Viral infections • Steven-Johnson's & TEN
• Thyroid cancers • Goitre • Cat scratch disease • Cholera • Chikungunya • Covid-19 • Eczema herpeticum 09.07 Dermatological infections
• Clostridiodes difficile • Diphtheria • Cytomegalovirus • Epstein-Barr • Staph scalded skin syndrome • Varicella / chickenpox
06.02 Adrenals • Escherichia coli • HFMD • HSV • Necrotising fasciitis • Herpes zoster / shingles
• Cushing's disease • Enteric fever (typhoid/paratyphoid) • Japanese encephalitis • HIV • Pityriasis rosea
• Adrenal insufficiency 09.02 Melanocytic lesions and mimickers • Hidradenitis suppurativa
• Hyperaldosteronism 08.02 Bacterial infections 08.07 Viral infections • Melanoma & differentials
• Phaeochromocytoma • H. influenzae • Klebsiella • Influenza • Measles • Seborrhoeic keratosis • Benign naevi 09.08 Miscellaneous
• Leptospirosis • Leprosy • Mpox • Orf • Mumps • Dermatofibroma • Pemphigus • Bullous pemphigoid
06.03 • Listeria • Lyme disease • Norovirus • Parvovirus • Pyoderma gangrenosum • Insect bites • Skin lesions
• Acromegaly • Prolactinoma • Meliodosis & other Burholderia • Poliovirus
• Hyperthyroidism & hypoparathyroidism • Mycoplasma pneumoniae 09.03 • Non-melanoma skin cancers 10.07 Platelet disorders
• Immune thrombocytopaenia
• Multiple endocrine neoplasia • Pseudomonas aeruginosa 08.09 Viral infections - BCC & SCC
• Thrombocytopaenia
• Salmonella • Shigella • Rabies • RSV • Rotavirus • Acne vulgaris
• Haemophilia
06.04 Diabetes melitus • Rubella • West Nile • Zika
• von Willebrand disease
• T1DM, T2DM 08.03 Bacterial infections • Viral haemorrhagic fevers, including 09.04 • Eczema • Psoriasis
© quackquackmed.com
• Neutropaenia
• Drugs used in DM • Insulin • Q fever • Staph. aureus Dengue, Ebola, Yellow Fever • Rosacea
• DVLA rules for diabetes • Coagulase-negative staphylococci
10.08 Blood products
• Complications of DM & sick day rules • Strep. pneumoniae 08.10 Genitourinary infections / STIs 09.05 Dermatological infections
• Packed red cells • Platelets
• Strep. pyogenes (incl scarlet fever) • Chlamydia • Gonorrhoea • Impetigo • Folliculitis
• CMV-ve and irradiated blood
06.05 • Strep agalactiae (GBS) • Bacterial vaginosis • Cellulitis & erysipelas
• FFP & cryoprecipitate
• Diabetic ketoacidosis • Tetanus & other Clostridia • Trichomonas vaginalis • Head lice • Scabies
• Hyperosmotic hyperglycaemic state • Yersinia pestis • Genital herpes • Genital warts • Prothrombin complex
• Cell saver devices
• Hypoglycaemia • Pubic lice • Donovanosis
10 HAEMATOLOGY & ONCOLOGY • Warfarin – Mx of high INR
• Diabetes insipidus 08.04 Bacterial & fungal infections • Syphilis • Chancroid
• Blood product transfusion
- Water deprivation test • Rickettsiae • Actinomyces & Nocardia • Ulcers in STIs
• Candida • Cryptococcosis 10.01 Haematological cancers complications, including TACO, TRALI
06.06 • Acid-base balance • Aspergillus • Mucormycosis 08.11 Helminth infections • ALL • CLL • Hairy cell leukaemia
• Hypercholesterolaemia • AML • CML • Myelofibrosis 10.09 Miscellaneous
• Histoplasmosis Incl Hookworm, Cutaneous larva
migrans, Strongyloides, Pinworm, • Myelodysplastic syndrome • Hereditary angioedema
• Polycythaemia vera • Hyposplenism • Splenomegaly
06.07 • Hyperkalaemia & hypokalaemia 08.05 Antibiogram Hydatid disease, Schistomiasis
• Thymoma • Lymphadenopathy
• Hypercalcaemia & hypocalcaemia
10.02 Haematological cancers • Drugs – anticoagulants, antiplatelets,
• Hypomagnesaemia 08.12 Protozoan infections
• Non-Hodgkin's lymphoma tranexamic acid
• Malaria • Toxoplasmosis
06.08 • Hyponatraemia (DDx) • Cryptosporidiosis • Chagas disease • Hodgkin's lymphoma
- SIADH • Multiple myeloma 10.10 Emergencies, organ transplants
• Sleeping sickness • Leishmaniasis
• Hypernatraemia 07.04 Infections of the urinary tract • Neutropenic sepsis
• Giardiasis • Amoebiasis
• Infectious cystitis including UTI 10.03 Primary immunodeficiencies • Tumour lysis syndrome
• Pyelonephritis • Epididymitis 08.13 Misc infections • Neutrophilia / phagocytes • Graft versus host disease (GVHD)
07 RENAL MEDICINE & UROLOGY • Prostatitis • Balanoposthitis • Superior vena cava syndrome
• Sepsis • Animal & human bites • T-cell disorders, incl DiGeorge's
• B & T-cell disorders, incl SCID • Organ transplant & rejection
• Cellulitis • Lemierre's syndrome
07.01 • Acute kidney injury (AKI) 07.05 • Urinary tract stones • Acute intermittent porphyria
• Spinal epidural abscess
• Chronic kidney disease (CKD) • Benign prostatic hyperplasia 10.11
• Hyposplenism • Diabetic foot infxn
- Renal replacement therapy • Erectile dysfunction • Common cancers • Tumour markers
• Vaccination schedule 10.04 Anaemia
• DDx chart + iron studies interpretation • Genetic conditions predisposing to
07.02 Glomerulonephritides 07.06 • Microcytic anaemia cancer
04.14 Misc infections
• IgA nephropathy • FSGS • Urological cancers: renal cell • Prescribing for palliative / end of life
• Diarrhoea DDx • Gastroenteritis
• ANCA glomerulonephritis carcinoma, bladder Ca, prostate Ca care
• List of other infections found in book 10.05 Anaemia
• Membranous GN • Myeloma kidney • Misc urology: circumcision, vasectomy, • Normocytic anaemia ÷ non-haemolytic
• Membranoproliferative GN priapism 10.12 Breast
and haemolytic anaemia
• Breast Ca • Fibroadenoma
07.03 • Diabetic nephropathy 07.07 Testicular lumps • Fibrocystic breast changes
10.06 • Microcytic anaemia
• Lupus nephritis • Inguinal hernia • Hydrocele • Methaemoglobinaemia • Fat necrosis • Lipoma
• Acute interstitial nephritis • Varicocele • Epididymal cyst • Thrombophilia • Phyllodes tumour • Galactocele
• Acute tubular necrosis • Epididymo-orchitis • Mammary duct ectasia
• Antiphospholipid syndrome
• ADPKD • Bartter & Gitelman • Testicular torsion • Testicular tumour • Duct papilloma • Lump description
• Thrombocytosis
, Acute kidney injury AKI Chronic kidney disease CKD
D: acute decline in kidney function Ix: D: abnormal kidney structure or function Mx: CKD-related anaemia
According to KDIGO, defined as • Bloods: U&Es ≥3mo 1. Slow progression • Pathophysiology
• ↑SCr ≥26.5 µmol/L in 48h, or • Urinalysis (consider intrinsic cause if • Optimise DM control - CKD → ↓erythropoietin → ↓RBC
• ↑SCr ≥1.5x baseline in last 7d +ve blood & protein; consider infxn if By definition this includes pts who only have
• Optimise HTN control production ∴ anaemia
• UO <0.5 mL/kg/h for 6h +ve nitites, leukocytes)
one kidney (eg kidney donors)
☝🏻
- ACEI or ARB - CKD → ↓absorption of iron
Further ÷ according to stages
• UO (?pts ideally on catheter to ensure
A: • diabetic nephropathy
↳ can cause small ↓GFR (≤↓25% ok) - Causes a normochromic normocytic
1. ↑SCr ≥26.5 µmol/L, or
accurate measurements) - SGLT2 inhibitors - evidence of benefit anaemia (normal Hb, just fewer RBC)
• hypertension
↑SCr 1.5-1.9x baseline, or • Imaging: renal US if no identifiable
cause or if judged to be at risk of
• chronic glomerulonephritis in reducing progression; dapaglifozin
only for now
- Can lead to left ventricular
hypertrophy
UO <0.5 mL/kg/h for 6-12h
2. ↑SCr 2.0-2.9x baseline, or
urinary tract obstruction
• chronic pyelonephritis
✌🏻
- furosemide (esp when GFR ≤45 • Mx: target Hb 10-12 g/dL
• adult polycystic kidney disease
☝🏻
© quackquackmed.com
UO <0.5 mL/kg/h for ≥12h • (others) mL/min; also helps ↓K) - iron supplementation to optimise
3. ↑SCr ≥3x baseline, or Mx: "STOP AKI" • Tx glomerulonephritis iron levels
↑SCr ≥353.6 µmol/L, or Sepsis - screen & treat ÷ into 6 grades by GFR
2. ↓risk of complications
- if no improvement, offer EPO-
analogues (eg darbepoietin)
UO <0.3 mL/kg/h for ≥24h, or Toxins - identify and stop G1. GFR >90 mL/min with evidence of
UO = 0 (anuria) for ≥12h, or • Stop as the worsen renal function: • Exercise, wt loss, stop smoking - pts may need blood transfusions
kidney damage (eg histopathology,
Initiation of RRT, or NSAIDs (except baby aspirin), amino- • Dietary advice
on imaging, on lab findings)
glycosides, ACEI, ARBs, diuretics - control dietary sodium intake esp
In pts <18yo, eGFR <35 mL/min G2. 60-89 mL/min Renal replacement therapy (RRT)
• Stop as AKI ↑risk of toxicity: metformin, G3a. 45-59 mL/min
• Atorvastatin 20 mg for 1' prevention of
SCr = serum creatinine cardiovascular disease
lithium, digoxin G3b. 30-44 mL/min Haemodialysis
A ÷ pre, intrinsic, post renal causes Optimise vol status and BP G4. 15-29 mL/min • Pt is hooked up to machine which
• IV crystalloid 500 mL bolus over 15 min 3. Treat complications "cleans" the blood
• Pre-renal causes G5 (end stage). GFR <15
-❗️ hypovolaemia (eg dehydration, (caution in HF, cirrhosis, etc)
• Withhold antihypertensives ÷ by albumin to creatinine ratio (ACR)
• Mineral bone disease Mx
• Anaemia Mx
• Usually required 3x/week, each
session lasts 3-5h
shock, diarrhoea)
- renal artery stenosis • Pt may require inotropes ↳ albumin and creatinine measured in • Access routes: arteriovenous fistula,
Prevent harm urine. Albumin is not normally excreted 4. End stage renal disease graft or central venous catheter
• Intrinsic renal disorders
• Tx reversible causes (eg obstruction) in urine (∴ ↑ACR indicates severity) • Renal replacement therapy
- glomerulonephritis
• Tx life-threatening complications A1. ACR <3 mg/mmol • Renal transplant Peritoneal dialysis
- acute tubular necrosis →next pg
= normal or mildly increased • At ESRD, if pt does not receive RRT,
↳ 45% cases (eg 2/2 sepsis) • Modify doses of meds
A2. ACR 3-30 mg/mmol their average life expectancy is ~6mo
• Filtration occurs in pt's abdomen
• Requires insertion of PD catheter
- acute interstitial nephritis →next pg = moderately increased
Renal replacement therapy (RRT) (surgically), via which pt can insert
- rhabdomyolysis (eg fall + long lie)
"AEIOU" indications A3. >30 mg/mmol = severe Mineral bone disease and drain PD fluid
- tumour lysis syndrome
• Post-renal causes • Acidosis (pH <7.1) • Pathophysiology • Continuous ambulatory PD - each
Note: protein:creatinine ratio (PCR) is also
- kidney stones in ureter/bladder
• Electrolyte imbalance, eg K>6.5
used to monitor kidney function, but ACR is - CKD → ↓vit D activation → ↓Ca exchange lasts 30-40 min, and the
- benign prostatic hyperplasia
• Intoxication ("SLIME" - salicylates, preferred in diabetics - CKD → ↓excretion of PO4 dwell time of fluid is 4-8h. Pt can go
- external compression of ureter lithium, isopropanol, methanol, - ↑PO4 also causes bone degradation about normal activities while the
ethylene glycol) ± drug overdose S/smx: • asmx early on, picked up on (osteomalacia) dialysis solution is in their abdomen
• Overload ± pulmonary oedema routine bloods - 2ndary hyperparathyroidism [→06.03] • Automated PD - pt is hooked up to
R: ↑age, underlying kidney disease (eg • Uraemia (pericarditis, encephalopathy, • unspecific s/smx - lethargy, anorexia machine that fills and drains
• Normalise PO4 levels
- ↓PO4 in diet
diabetic nephropathy), hospitalisation for end organ failure) (wt loss), insomnia, NV abdomen overnight
various causes (15% inpatients develop • in later stage kidney failure, pts can - PO4 binders (eg sevelamer)
AKI), drugs (eg NSAIDs, amino-
glycosides, ACEIs, ARBs, diuretics)
Mx of hyperkalaemia develop anaemia, pruritus (2/2 uraemia) ↳ avoid calcium based binders as Renal transplant
• Kidney from live or deceased donor –
- Cardiac protection with IV calcium they can cause hyperCa and
chloride or calcium gluconate + ECG usually placed in the right or left iliac
vascular calcification
- IV insulin/glucose + salbutamol neb Ix: • bloods (U&Es) fossa and attached to external iliac
S/smx: • may be asmx until late • Normalise vit D levels
• Usually picked up on routine bloods or - (see notes on hyperkalaemia) • Urinalysis + ACR/PCR vessels
when ↓UO
• Imaging ± biopsy - Supplementation: alfacalcidol
• Normalise PTH levels
↳ native kidneys remain
• Pulmonary & peripheral oedema • Requires life long immuno-
- parathyroidectomy if severe
• Arrythmias 2/2 electrolyte disturbances suppression to prevent rejection
• Features of uraemia, eg encepha- • Lifespan of donor kidney is ~10-15y
lopathy, pericarditis
07.01 Renal & Urology – AKI & CKD
