AKI CKD

Question 1

what is AKI

Answer 1

a rapid reduction in kidney function leading to an inability to maintain electrolyte acid base and fluid homeostasis

Question 2

How is AKI defined based on creatinine

Answer 2

stage 1 increase by >26, or 1.5-1.9x the reference
stage 2 increase by 2.0 to 2.9 x the reference
stage 3 increase by >3 x the reference

Question 3

why does pre renal AKI occur

Answer 3

poor perfusion - due to failure of normal adaptive mechanisms designed to maintain renal perfusion (baroceptors activated by low BP, activation of ras, release of vasopressin)

Question 4

which drugs may predispose patients to develop pre-renal AKI

Answer 4

NSAIDS - decrease afferent arteriolar dilatation, calcineurin inhibitors - decrease afferent arteriolar dilation, ACEi or ARBs - decrease efferent arteriolar constriction, diuretics - affect tubular function, decrease preload

Question 5

whats the difference between pre renal AKI and ATN with regards to responding to restoration of circulating volume

Answer 5

prerenal responds but AKI does not

Question 6

name some causes of post renal AKI

Answer 6

hallmark is physical obstruction to urine flow, intrarenal, ureteric, prostatic, blocked catheter

Question 7

what are some causes of intrinsic AKI

Answer 7

vascular disease, glomerular, tubular, interstitial disease e.g. analgesic nephropathy

Question 8

direct tubular injury causes

Answer 8

ischaemic, endogenous toxins e.g. myoglobin, immunoglobulins, exogenous toxins e.g. aminoglycosides, amphotericin, acyclovir

Question 9

why do same cases of AKI not improve

Answer 9

imbalance between scarring and remodelling

Question 10

stages of CKD

Answer 10

Normal GFR >90 ml/min
mild 60+
moderate 30+
severe 15+
endstage <15

Question 11

commonest causes of CKD

Answer 11

diabetes, atherosclerotic, hypertension, glomerulonephritis, infective, PCKD

Question 12

consequences of CKD

Answer 12

failure of homeostasis - acidosis, hyperkalaemia, progressive failure of hormonal function - anaemia (epO), renal bone disease, cardiovascular - uraemic cardiomyopathy, vascular calcification

Question 13

how to treat anaemia of chronic renal disease

Answer 13

erythropoeitin stimulating agents like eprex

Question 14

renal bone disease types

Answer 14

osteitis fibrosa (osteoclast resorption of calcified bone and replacement by fibrous tissue) osteomalacia, adynamic bone disease, mixed osteodystrophy

Question 15

hyperparathyroidism in CKD

Answer 15

hypocalcaemia, leads to hyperparathyroidism, resistance to PTH and more hyperparathyroidism

Question 16

treatment of renal bone disease

Answer 16

phosphate control, phostphate binders, vitamin D receptor activators (1 alpha calcidol), direct PTH suppression e.g. cinacalcet

Question 17

stages of uraemic cardiomyopathy

Answer 17

LV hypertrophy, lv dilatation, lv dysfunction

Question 18

patient has new onset AKI after severe bruising

Answer 18

rhabdomyolysis

Question 19

what two measures do we use to define AKI

Answer 19

urine output and creatinine

Question 20

contraindication to renal transplant

Answer 20

active sepsis

Question 21

A 68 year old man with previously normal
renal function is found to have a creatinine of
624μmol/l. Renal ultrasound shows dilatation of both kidneys. What is the likely
cause of his AKI?(

Answer 21

Benign prostatic hypertrophy