6- CKD and AKI

Question 1

What is an AKI

Answer 1

Renal function deterioration over hours/days

Question 2

What rises in AKI (Blood)

Answer 2

Urea and creatinine

Question 3

Is AKi reversible

Answer 3

Can be

Question 4

Consequences of AKI

Answer 4

Volume overload, metabolic acidosis, hyperkalemia

Question 5

What causes the most AKIs

Answer 5

Pre renal cause

Question 6

Pre-renal causes

Answer 6

Hypovolemic
Shock
Renal artery stenosis
NSAIDs and ACEI

Question 7

How do NSAIDs and ACEI cause AKI

Answer 7

Impair mechanism of renal autoregulation

Question 8

Intrinsic causes of AKI

Answer 8

Acute tubular necrosis- ischemia, rhabdomyolysis, drug toxicity, toxins

Acute interstitial nephritis- drugs, hypercalcemia, myeloma

Glomerular disease- acute glomerulonephritis, rapidly progressive glomerulonephritis.

Vascular disease- vasculitis, malignant hypertension, thrombotic microangiopathies

Question 9

What is a sign of Rhabdomyolysis

Answer 9

Dark urine. Muscle breakdown–> myoglobin –> filtered but toxic.

Question 10

Post renal causes of AKI

Answer 10

Bladder outflow obstruction
Tumour
Stone- bilateral to cause AKI
Retroperitoneal fibrosis causing ureteral obstruction

Question 11

Basic investigations

Answer 11

Urine test- microscopy, dipstick, cytology
Bloods
Imaging

Question 12

What biochemical changes occur

Answer 12

Increased plasma urea, creatinine, urate, phosphate, potassium
Decreased plasma sodium, calcium
Metabolic acidosis
Increased anion gap

Question 13

How to manage AKI

Answer 13

Fluid replacement to optimise flow and correct hypovolemia
Correct electrolyte imbalances
Catheter if obstruction

Question 14

What are the life threatening complications of AKI

Answer 14

Hyperkalemia
Pulmonary oedema
Bleeding

Question 15

What is CKD

Answer 15

Progressive loss of function over months and years

Question 16

Is CKD reversible

Answer 16

No, renal tissue replaced by extracellular matrix in response to damage.

Question 17

Whats a good GFR

Answer 17

> 90

Question 18

Stage 2

Answer 18

60-89

Question 19

Stage 3

Answer 19

30-59

Question 20

Stage 4

Answer 20

15-29 RRT

Question 21

Stage 5

Answer 21

<15 -dialysis or transplant

Question 22

Increased incidences in what people

Answer 22

Ethnic, elderly, multi-morbid, social deprivation, diabetes, hypertension

Question 23

Pathology of CKD- what happens to kidney

Answer 23

Medulla maintains but cortex (where nephrons are) thin.

Question 24

Who gets CKD screening

Answer 24

Diabetes
Hypertension
CVD
Those on nephrotoxic drugs

Question 25

What blood tests to use

Answer 25

``` U&Es eGFR Bone biochemistry FBC CRP Iron PTH ```

Question 26

Other investigations for CKD

Answer 26

USS- kidney size Biopsy CT MRI

Question 27

Management

Answer 27

``` Lifestyle modification Uncontrolled diabetes control Hypertension control Proteinuria - ACEI Lipid control ```

Question 28

What are the functions of the kidneys

Answer 28

BP, volume, pH, electrolytes, osmolality, excretion of waste, metabolism of drugs

Question 29

What is the endocrine function of the kidneys

Answer 29

Inactive Vit D, renin, EPO

Question 30

Water handling in kidney during CKD

Answer 30

Reduced GFR means lost ability to maximally dilute and concentrate urine.

Question 31

Nocturia in CKD

Answer 31

Small filtrate but same solute loads causes osmotic diuresis- reduces maximum concentrating ability and response to ADH

Question 32

Effect on low GFR on K+ (and ACEI)

Answer 32

Hyperkalaemia | Need to stop ACEI as aldosterone helps to excrete K+ by increasing ROMK expression

Question 33

CKD and bone mineral disease

Answer 33

Decreased activation of Vit D = less Ca = PTH stimulated = bone breakdown. As kidneys aren't functioning well then PO4 isn't excreted = precipitates = vessels, joints, skin. Manage: give Vit D supplements

Question 34

Drug sensitivity in CKD

Answer 34

Increased as elimination is impaired.

Question 35

Accumulation of waste products- symptoms

Answer 35

Uraemic symptoms- reduced appetite, nausea and vomiting, pruritus

Question 36

End stage renal failure

Answer 36

GFR < 15mls/min | Requires RRT

Question 37

Symptoms of dialysis

Answer 37

Tiredness, sleep issues, concentration issues, volume overload, nausea, restless legs, sexual dysfunction, increased infection

Question 38

Hemodialysis times and pills

Answer 38

4 hrs x 3 times a week + 19 tablets, EPO and iron

Question 39

Peritoneal dialysis

Answer 39

4-5 bags and day or overnight

Question 40

Transplant

Answer 40

Reduced morbidity and mortality QOL Infection risk Immunosuppressants- diabetes, hypertension risk