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"