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14.03.04 Revision notes

Indications for dialysis in AKI
  • Potassium >6
  • pH <7.2 or bicarb <10
  • Pulmonary oedema without diuresis
  • Uraemic pericarditis
  • Uraemic encephalitis

Four functions of the kidney
  • Excretion
  • Regulation
  • Metabolism
  • Endocrine

Infections in pregnancy
  • Chicken pox
    • Risk to mother (pneumonia) and to baby (fetal varicella syndrome)
    • Specialist advice may recommend oral aciclovir 800 mg x 5 daily for 5-7 days if >20 weeks
    • No role for varicella immunoglobulin once infection has been contracted
    • If in late pregnancy => Premature delivery => Neonatal chickenpox
      • Treat with immunoglobulin and aciclovir
  • Rubella
    • Risk of congenital rubella syndrome
      • Infection in the first 8-10 weeks of pregnancy results in damage in up to 90% of surviving infants
      • The risk of damage reduces to 10-20% if the infection is in the first 11-16 weeks of pregnancy
      • Fetal damage is rare over 16 weeks of gestation
    • No treatment
    • Offer TOP if positive IgM in the first 16 weeks of pregnancy
  • Measles
    • Risk to mother (measles pneumonia)
    • Prophylactic vaccination if unimmunised (vaccine stimulated immune response faster than organism)
  • Parvovirus B19
    • Risk to foetus
    • 30% chance of transfer to baby; 5-10% chance of fetal loss
    • Especially in first trimester
    • Test for parvovirus B19 (and rubella) IgM and IgG as soon as possible after contact with, or symptoms of, a rash illness
    • Refer to specialist centre (Fetal blood sampling / intrauterine transfusion of erythrocytes / early delivery)

  • Angiotensin II is a potent vasoconstrictor as well as stimulating aldosterone release
  • Consequence of high phosphate in CKD
    • Pyrophosphate arthropathy
    • Calcinosis cutis 
      • Phosphate => calcium deposition as CaPi
      • When the calcium-phosphate product exceeds 70 mg2/dL2
  • KEEP GIVING calcium gluconate until ECG normalises
  • Amiodarone is a P450 inhibitor 
    • Many interactions, e.g. with statins => rhabdo
  • nsAid affect Afferent, acEi affects Efferent
  • ACEi => Efferent vasodilatation => Reduced hypertensive renal damage
    • But in renal artery disease the kidneys rely on efferent vasoconstriction to maintain renal blood flow
  • Dietary protein => Acidosis
    • Restrict in CKD
  • Parvovirus B19 = Slapped cheek = Erythema infectiosum
  • Measles is the most infectious disease known to man
    • Any face-to-face contact / 15 minutes in the same room
  • Children under 12 months do not respond to MMR vaccination
    • Maternal antibodies neutralise it
    • May give some protection in an epidemic, but ignore a pre-12 month dose otherwise
  • Meningitis PEP is with CIPROFLOXACIN
    • Single dose 500 mg
    • NOT rifampicin
    • For overnight stay / kissing contacts
  • Protective Neisseria strains are killed by ciprofloxacin PEP => Only give to those that are indicated
  • Leigionella 
    • No known cases of human-human transmission
    • Only grows if water is between 20 and 45 degrees
  • "Doesn't know if it's Tuesday or wheelbarrows"