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)

Notes

• • 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"