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PPT Phase II > AKI and CKD > Flashcards

AKI and CKD Flashcards

1
Q

list some risk factors for AKI

A 
CKD (eGFR <60 and/or hx of proteinuria)
age >75yrs
HF
Liver disease
CVD (previous MI, stroke, PVD)
DM
recent use of nephrotoxins
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2
Q

List the 2 things that can be measured to stage AKI

A
  • serum creatinine

- urine output

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3
Q

in the KDIGO staging system for AKI, what would stage 1 be defined as?

A
  • rise of >26 micromol/L within 48hrs
    or
  • rise of >1.5 - 1.9x baseline serum creatinine
    or
  • <0.5mL/Kg/hr urine output for >6 consecutive hrs
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4
Q

list 4 common causes of AKI

A
  • sepsis
  • hypoperfusion
  • medications
  • obstruction
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5
Q

on examination what could you do to test teh fluid status of a pt?

A
  • cap refill (<3s)
  • PR
  • BP
  • skin turgor
  • JVP
  • Oedema
  • fluid balance charts
  • daily weights
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6
Q

List 5 complications of AKI

A
  • hyperkalaemia
  • acidosis
  • acute confusion (uraemic encephalopathy)
  • pulmonary oedema
  • pericarditis
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7
Q

What would you want to be looking for in the biochemistry profile of a person with AKI?

A 
Urea
LFTs
electrolytes
Glucose
Creatinine
Bone profile
Bicarbonate
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8
Q

what would you be looking for in a full blood count in someone with AKI?

A

looking for evidence of haemorrhage or sepsis.

low platelets may occur with sepsis or haemolytic uraemic syndrome/thrombotic thrombocytopenic purpura

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9
Q

why would you do urinalysis on someone with AKI?

A

to check for abnormal protein or blood.

to rule out UTI

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10
Q

A pt comes in with AKI and has previous cardiovascular problems which he takes medication for and he has a low BP. what immediate therapy would you do?

A

IV fluid therapy – fluid challenge = 500 mL 0.9% NaCl over fifteen minutes
Withdrawal of nephrotoxins
Withholding of hypotensive agents and diuretics
Withhold atorvastatin

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11
Q

a mnemonic for remembering some nephrotoxic drugs is SADMANGON - list the drug classes

A 
Sulphonylureas
ACEi/ARBs
Diuretics
Metformine
Aldosterone inhibitors
NSAIDs
Gabapentin
Opioids
NOACs (fractionated heparins)

NB penicillin-based abx, aminoglycosides and aciclovir are also nephrotoxic

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12
Q

Name 3 principles of managing AKI

A
  1. optimise intra-vascular fluid volume - IV fluids
  2. optimise BP - withhold drugs that interfere with renal autoregulation (ACEi. ARBs), temporarily stop all drugs that induce hypotension (hypertensives)
  3. Prescribe appropriately - stop and avoid nephrotoxic drugs
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13
Q

why does serum potassium sometimes increase in AKI?

A

mainly due to reduced renal potassium excretion due to AKI combined with the actions of potassium sparing drugs (e.g. spironolactone) and ACEi whcih reduce the effect of aldosterone.

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14
Q

what effect does NSAIDs and ACEi have on the kidney arterioles?

A

NSAIDs cause vasoconstriction of afferent arteriole.

ACEi’s cause vasodilation of efferent arteriole so together they reduce eGFR.

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15
Q

what symptoms can you get with hyperkalaemia?

A

usually asymptomatic.

can get weakness, paraesthesia, palpitations

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16
Q

what are the signs on an ECG of hyperkalaemia?

A
  • peaked T-waves
  • prolonged PR interval and eventual loss of p-wave
  • QRS widening
  • AV dissociation
  • VF or VT
17
Q

How do you treat mild hyperkalaemia caused by AKI?

A

treat the cause of AKI

18
Q

when should you treat hyperkalaemia in AKI?

A

if K>6.5 mmol/L or if there are ECG changes

19
Q

what is the immediate treatment of hyperkalaemia if K+ is >6.5mmol/L or there are ECG changes?

A

IV 10ml 10% calcium gluconate over 2-5mins.

note that this is to stabilise the myocardium but has no effect on serum potassium conc.

20
Q

what cells in the kidney tubules are responsible for responding to changes in the rate of flow and the composition of tubule fluid?

A

Macula densa cells

21
Q

hypokalaemia can increase the effects and toxicity of certain drugs. name 2 classes

A 
cardiac glycosides (digoxin).
class III antidysrhythmic drugs
22
Q

which class of diuretics are considered the most powerful? Give 2 examples

A

loop diuretics e.g. furosemide, bumetanide

23
Q

name some adverse effects of look diuretics

A
  • hypovolaemia and hypotension
  • hypokalaemia and metabolic acidosis
  • hyperuricaemia whcih can ppt gout
  • reduced renal perfusion and pre-renal impairment
24
Q

in what situation would you give IV furosemide rather than oral?

A

for urgent situations e.g. acute pulmonary oedema

or when intestinal absorption is impaired.

25
Q

what equation can be used to measure the creatinine clearance?

A

Cockcroft-Gault

26
Q

renal funciton measured in terms of GFR is calculated from a formula derived from what study?

A

the Modification of Diet in Renal Disease study (‘MDRD formula’)

27
Q

For most people, eGFR can be used to adjust drug doses. in what situations would you use creatinine clearance calculated from teh Cockcroft and Gault formula to adjust drug dosages?

A
  1. for potentially toxic drugs with a small safety margin

2. in pts at both extremes of weight (BMI <18.5 or >30

28
Q

What drugs, metabolised and excreted by the kidneys, need to be dose adjusted for in a pt with an eGFR of <10?

A 
MAPS OF:
Metformin
Aciclovir
pencillin-based abx
Sulfonylureas
Opiates
Fractionated heparins
29
Q

Name 3 drugs that require close monitoring in someone with renal failure

A
  1. Warfarin
  2. Aminoglycosides - e.g. gentamicin, tobramycin
  3. Lithium
30
Q

Name 3 drugs that aggravate hyperkalaemia by blocking renal excretion of potassium

A
  1. Trimethoprim
  2. Spironolactone
  3. Amiloride (potassium-sparing diuretic)
31
Q

Name 4 things you would do in an initial assessment when suspecting AKI

A
  1. ABCDE assessment
  2. observations - check NEWS score
  3. look for signs of sepsis
  4. Abdominal palpation to look for full bladder

PPT Phase II (37 decks)

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