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MB2: Renal > AKI and CKD > Flashcards

AKI and CKD Flashcards

1
Q

definition of AKI

A

decreased renal function <48hrs
increase in creat >50%
OR reduction in UO
OR increase in serum creat by >26.4micromol/l

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2
Q

risk factors for AKI

A 
older age 
CKD
diabetes 
cardiac failure 
liver disease
PVD
Previous AKI 
drugs 
hypotension/hypovolaemia 
sepsis
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3
Q

causes of pre renal AKI

A

hypovolaemia
hypotension
sepsis/anaphylaxis
renal hypoperfusion, ACEI/ARB, NSAIDs, hepatorenal syndrome

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4
Q

renal causes AKI

A

vasculitis, renovascular
glomerulonephritis
abx, omeprazole, NSAIDs, sarcoid, TB
ischaemia, gentamicin, contrast, rhabdomyalysis

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5
Q

causes of post renal AKI

A

stones
tumour
stricture
swelling

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6
Q

what is oliguria

A

UO <0.5ml/kg/hr

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7
Q

describe how ACEI/ARB leads to pre renal AKI

A

reduced renal perfusion leads to raised renin, ATII stimulation and efferent arteriole constriction to preserve GFR
this is lost in ACEI so loss of volume results in massive loss of GFR

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8
Q

what does untreated pre renal AKI lead to

A

acute tubular necrosis

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9
Q

what may lead to acute tubular necrosis

A

drug toxicity, rhabdomyalysis

sepsis, severe dehydration

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10
Q

management of pre renal AKI

A

monitor UO, HR, BP, JVP, CRT, pulmonary oedema

give 1L crystalloid and seek urgent nephrology help

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11
Q

signs and symptoms of AKI

A 
anorexia 
weight loss 
fatigue 
nausea and vomiting 
itch 
SOB, pitting oedema 
HTN
effusion 
pericarditis 
oliguria
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12
Q

signs more specific to renal AKI

A 
sore throat 
rash 
arthralgia 
D&V
haemoptysis 
recent contrast 
vascular bruit
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13
Q

eosinophilia in the context of AKI is indicative of?

A

interstitial nephritis

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14
Q

raised CK in the context of (renal) AKI is indicative of?

A

rhabdomyalysis

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15
Q

investigations for renal AKI

A

Na,K,Ur,Cr, clotting, Hb, urinalysis
USS
ANA,ANCA,GBM
protein electrophoresis and BJP

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16
Q

treatment of renal AKI

A 
fluid resus and pressors 
treat underlying cause 
abx if septic 
stop ALL nephrotoxics 
dialysis if still anuric and uraemic, they may need it URGENT
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17
Q

life threatening complications of AKI

A

hyperkalaemia
fluid overload
uraemic pericardial effusion

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18
Q

what is regarded as severe uraemia

A

> 40

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19
Q

managing post renal AKI

A

catheterise, nephrostomy

refer to urology

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20
Q

normal serum K

A

3.5-5

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21
Q

serum hyperkalaemia

A

> 5.5

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22
Q

life threatening severe hyperkalaemia

A

> 6.5

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23
Q

ECG features of hyperkalaemia

A 
peaked T wave
flattened P
prolonged PR 
depressed ST
prolonged QRS 
sine wave pattern
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24
Q

management of hyperkalaemia

A 
10ml 10% calcium gluconate 
cardiac monitor 
IV access
insulin, dextrose, salbutamol 
calcium resonate if stable 
bicarb considered
25
urgent indication for haemodialysis
hyperkaemia >7 or 6.5 despite tx acidosis <7.15 fluid overload urea >40 with pericardial rub/effusion
26
drugs to avoid in AKI
``` NSAIDs ACEI/ARB Diuretics contrast gentamicin trimethoprim potassium sparing diuretics ```
27
what is CKD
reduction in kidney function/structural damage | >3m with health implication
28
markers of kidney damage?
``` transplant histological abnormalities electrolyte abnormalities ACR >3 sediment in urine structural abnormalities ```
29
stage 1 CKD
>90ml/min
30
stage 2 CKD
60-89ml/min
31
stage 3a CKD
45-59ml/min
32
stage 3b CKD
30-44ml/min
33
stage 4 CKD
15-29ml/min
34
stage 5 CKD
<15ml/min
35
class A1 CKD
<3
36
class A2 CKD
3-30
37
class A3 CKD
>30
38
worst stage of CKD
stage 5 class A3
39
what is accelerated progression in CKD
persistent decrease in eGFR >25% and change in category within a year
40
cause of CKD
``` diabetes hypertension glomerular disease familial nephrotoxic drugs obstructive uropathy PKD systemic obesity and metabolic syndrome ```
41
nephrotoxic drugs causing CKD?
``` ACEI/ARB diuretics aminoglycosides bisphosphonates calcineurin inhibitors lithium mesalazine NSAIDs ```
42
obstructive uropathies causing CKD?
``` stricture tumour calculi extrinsic compression from lymph nodes/colon gynae masses ```
43
systemic causes of CKD
SLE vasculitis myeloma
44
familial causes of CKD
ADPKD alport syndrome familial GN
45
true/false - increase in urine ACR leads to raised risk stroke
true
46
what are the uraemic related risk factors on CV health
``` oxidative stress inflammation endothelial dysfunction vascular calcification subclinical hypothyroidism insulin resistance atherosclerotic plaques volume overload uraemic bone disease ```
47
cause and symptoms of renal anaemia
tiredness, SOB, lethargy, palpitations | decreased production of erythropoietin by kidneys
48
pathophysiology of renal mineral and bone disorder
disturbed vitamin D, calcium, PTH and phosphate due to impaired intestine absorption abnormalities in bone turnover, mineralisation due to vit D deficiency, raised PO4, low calcium and secondary/tertiary hyperparathyroidism
49
symptoms of renal mineral and bone disorder
bone pain, fragility, extra skeletal calcification
50
complications of CKD
``` renal anaemia dyslipidaemia hypertension cardiovascular disease renal mineral and bone disorder AKI ```
51
BP target for CKD
<140/90 | <30/80 if there is CKD and diabetes
52
risk modification treatment for cardiovascular complications?
``` stop smoking weight loss aerobic exercise low salt diet control HTN lipid lowering consider antiplatelet ```
53
if starting ACEI, what is considered a normal decline in GFR and rise in creat
<25% drop eGFR <30% rise creat should stabilise
54
what diet advice should be offered to patients with CKD
low phosphate, potassium and sodium diet
55
what can be given for CKD related metabolic acidosis and what is a complication?
sodium bicarbonate | can exacerbate fluid retention
56
medications for renal bone mineral disorder
active vitamin D alfacalcidol phosphate binders
57
who is more at risk of renal anaemia
eGFR<45ml/min | diabetics
58
Hb target for renal anaemia
100-120g/L | can be lower if on iron replacement and asymptomatic
59
what can be given for renal anaemia
oral iron usually IV iron in later CKD erythropoietin stimulating agent if really needed

MB2: Renal (11 decks)

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