general knowledge

Question 1

Diagnostic criteria for AKI

Answer 1

increase in serum Cr of ≥26 micromol/ L in <48h
≥50% increase in serum Cr known/ presumed to have occurred in <7d
decrease in urine output to <0.5mL/ kg/ h for >6h in adults and >8h in
children/ young people
≥25% decrease in eGFR in children/ young people in <7d

Question 2

indications for urgent dialysis

Answer 2

++++++AEIOU++++++

Acidosis
Electrolyte abnormalities (hyperkalemia)
Ingestions (salicylates, theophylline, methanol, barbiturates, lithium, ethylene glycol)
Overload (fluid)
Uremic symptoms (pericarditis, encephalopathy, bleeding, nausea, pruritus, myoclonus)

Question 3

high AG metabolic acidosis causes?

Answer 3

MUDPILES:
Methanol (formic acid)
Uremia
Diabetic ketoacidosis
Propylene glycol
Iron tablets or INH
Lactic acidosis
Ethylene glycol (oxalic acid)
Salicylates (late)

Question 4

normal AG metabolic acidosis causes?

Answer 4

HARDASS:
Hyperalimentation
Addison disease
Renal tubular acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline infusion

Question 5

define each factor for RTA type I (Distal)
Defect
Serum K+
Urinary pH
Etiologies (most common)
Treatment
Complications

Answer 5

Defect: H+ secretion
Serum K+: Low
Urinary pH: > 5.5
Etiologies (most common): Autoimmune disorders, hypercalciuria, amphotericin B
Treatment: K+ bicarbonate supplementation
Complications: Nephrolithiasis

Question 6

define each factor for RTA type II (Proximal)
Defect
Serum K+
Urinary pH
Etiologies (most common)
Treatment
Complications

Answer 6

Defect: HCO3 − reabsorption
Serum K+: Low
Urinary pH: 5.5 or high at onset
Etiologies (most common): Multiple myeloma, amyloidosis, all other causes of Fanconi syndrome (eg genetic and acquired), aminoglycosides, ifosfamide, cisplatin, acetazolamide
Treatment: Treat underlying cause, often needs sodium and K+ bicarbonate
supplementation
Complications: Rickets, osteomalacia

Question 7

define each factor for RTA type IV (impaired mineralocorticoid effect)
Defect
Serum K+
Urinary pH
Etiologies (most common)
Treatment

Answer 7

Defect: Aldosterone deficiency or resistance
Serum K+: High
Urinary pH: variable
Etiologies (most common): Hypoaldosteronism, angiotensin II inhibition (ACEIs/ARBs), urinary tract obstruction, heparin
Treatment: Depending on etiology, may need mineralocorticoid replacement, sodium bicarbonate supplementation, or K+ wasting diuretics