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Question 1

What is:
- creatinine
- urea

Answer 1

Creatinine
- break down of creatine (produced by muscle) - this is not reabsorbed so can be a good measure of flow through the kidneys (SERUM creatine in AKI)

Urea
- further breakdown product that is taken out through the kidneys

Question 1

Describe the passage fluid takes from through the nephron

Answer 1

Glomerulus
Bowman’s capsule
Proximal convoluted tubule
Loop of henle
Distal convoluted tubule
Distal collecting duct

Question 2

What are the causes of AKI

Answer 2

Pre-renal
- hypovolaemia (GI loss, haemorrhage or burns)
- hypotension
- renal artery stenosis/aortic dissection

Renal (problems with nephrons)
- DAMN drugs
- Acute tubular necrosis (epidethial cells of nephron die - myoglobin also damages cells)
- acute interstitial nephritis (inflammation of the intersititium of kidney)
- glomerular disease (anti glomeular basement membrane disease (Good pastures disease), post infection glomerulitis)
- thrombosis/emboli

Post-renal (obstruction to urinary flow)
- External (external tumour or BPH)
- Internal (stricture, tumour or renal stones)

Question 3

What happens to GFR during AKI?

Answer 3

It reduces - hence raise in serum creatinine

Question 4

What do each of the following on urine sample suggest
- muddy brown casts
- red casts
- wbc casts

Answer 4

Muddy brown = necrosed cells = acute tubular necrosis

Red casts = inflamed cells = glomerulonephritis

WBC = acute intiersital nephritis

Question 5

How do you calculate fluid maintenance for paediatric pts?

Answer 5

421 rule

4ml/kg/hr for first 10kg
2ml/kg/hr for next 10kg
1ml/kg/hr for weight above 20kg