Nephrology Practice Flashcards

This set of vocabulary flashcards covers essential terminology, diagnostic criteria, and clinical signs from the Nephrology lecture notes, including AKI, CKD, glomerular diseases, and electrolyte/acid-base disorders.

Acute Kidney Injury (AKI)

A clinical syndrome characterized by a sudden, rapid decline in renal function, leading to the accumulation of nitrogenous waste products (urea and creatinine) and dysregulation of fluid and electrolytes.

KDIGO Criteria (AKI)

Criteria defining AKI as an increase in serum creatinine by $\geq 26.5\,\mu mol/L$ within 48 hours, an increase to $\geq 1.5 \times$ baseline within 7 days, or urine volume $< 0.5\,mL/kg/hr$ for $\geq 6$ hours.

Oliguria

A mean urine volume of $< 0.5\,mL/kg/hr$ for $\geq 6$ hours.

RIFLE Criteria

An older classification system for renal impairment standing for Risk, Injury, Failure, Loss, and End-Stage Renal Disease (ESRD).

Pre-renal AKI

The most common subtype of AKI (60%) where the kidney is structurally functional but perfusion is reduced due to hypovolaemia, hypotension, or decreased circulating volume.

Intra-renal (Intrinsic) AKI

Kidney failure (30% of cases) where the pathology lies within the kidney parenchyma itself, often due to Acute Tubular Necrosis (ATN), ischaemia, toxins, or inflammation.

Post-renal AKI

A 'plumbing issue' (10% of cases) where renal function is impaired because the outflow of urine is blocked by obstructions like BPH, stones, or tumours.

AEIOU Mnemonic

Indications for acute dialysis: Acidosis (pH $< 7.2$), Electrolyte imbalance (refractory hyperkalaemia), Ingestions (toxic alcohols, lithium), Overload (refractory pulmonary oedema), and Uraemia (pericarditis, encephalopathy).

Polyuric Phase of AKI

A critical recovery phase (~2 weeks) where urine output increases massively because the kidneys begin to recover GFR but cannot yet concentrate urine, risking 'post-obstructive diuresis'.

Chronic Kidney Disease (CKD)

A progressive, irreversible decline in kidney function defined as kidney damage or a decreased GFR of $< 60\,ml/min/1.73m^2$ lasting for $\geq 3$ months.

Hyperfiltration

A compensatory mechanism where remaining healthy nephrons work harder to maintain GFR after a portion of nephrons are destroyed, eventually leading to structural damage and protein leak.

CKD-Mineral Bone Disease Triad

The classic biochemical pattern of low calcium, high phosphate, and high parathyroid hormone (PTH) in failing kidneys.

ADAM-H Mnemonic

Five causes of CKD that present with normal or enlarged kidneys on ultrasound: Autosomal Dominant Polycystic Kidney Disease, Diabetic Nephropathy, Amyloidosis, Myeloma, and HIV-Associated Nephropathy.

Uraemic Fetor

An ammoniacal, musty breath odour found in advanced CKD caused by urea breaking down into ammonia in the saliva.

Uraemic Frost

A white powder formed by the precipitation of urea out of sweat on the skin in terminal, neglected CKD.

Asterixis

A flapping tremor of the hands often seen in patients with uraemic encephalopathy.

Haemodialysis (HD)

A renal replacement therapy where blood is pumped out of the body and passed over a semi-permeable membrane against dialysis fluid to remove toxins.

Peritoneal Dialysis

A form of renal replacement therapy using the patient's own peritoneal membrane as a filter to allow toxins to diffuse into infused fluid.

Nephrotic Syndrome

A clinical triad/tetrad of proteinuria ($> 3.5\,g/24\,hours$), hypoalbuminaemia ($< 30\,g/L$), oedema, and hypercholesterolaemia.

Minimal Change Disease (MCD)

The most common cause of nephrotic syndrome in children, characterized by normal light microscopy but podocyte foot process effacement on electron microscopy.

Focal Segmental Glomerulosclerosis (FSGS)

The most common cause of nephrotic syndrome in adults, characterized by sclerosis and hyalinosis affecting only some glomeruli and parts of those glomeruli.

Kimmelstiel-Wilson Nodules

Pathognomonic tiny balls of protein in the mesangium seen on light microscopy in diabetic glomerulonephropathy.

Nephritic Syndrome

A clinical syndrome of immune-mediated glomerular inflammation presenting with haematuria, RBC casts, renal failure, hypertension, and oliguria.

Red Blood Cell (RBC) Casts

A pathognomonic finding in the urine sediment that indicates glomerulonephritis (GN).

IgA Nephropathy (Berger’s Disease)

The most common primary GN worldwide, presenting with macroscopic haematuria concurrently (within 1-3 days) with an upper respiratory or GI infection.

Goodpasture’s Disease (Anti-GBM)

A Type II hypersensitivity reaction where autoantibodies target the $\alpha 3$ chain of Type IV collagen in the glomerular and alveolar basement membranes.

Anion Gap (AG)

A measurement of unmeasured anions in the blood calculated as $Na^+ - (Cl^- + HCO_3^-)$; the normal range is typically $10-14\,mmol/L$.

MUDPILES

A mnemonic for causes of High Anion Gap Metabolic Acidosis (HAGMA): Methanol, Uraemia, DKA, Paraldehyde/Phenformin, Iron/INH/Isoniazid, Lactate, Ethylene glycol, and Salicylates.

Diabetes Insipidus (DI)

A condition characterized by massive polyuria and dilute urine ($< 250\,mOsm/L$) despite high blood sodium, caused by a lack of or resistance to ADH.

Chvostek’s Sign

A clinical sign of hypocalcaemia where tapping the facial nerve triggers a twitch of the facial muscles.

Trousseau’s Sign

A clinical sign of hypocalcaemia where inflating a BP cuff above systolic pressure for 3 minutes triggers a carpopedal spasm of the hand.

Fibromuscular Dysplasia (FMD)

A non-atherosclerotic cause of renal artery stenosis that typically affects young women ($< 30\,years$).

Sterile Pyuria

The presence of white blood cells in the urine without evidence of infection, often seen in tubulointerstitial nephritis.