Geriatrics Flashcards
MUST score
Screening tool to identify adults, who are malnourished, at risk of malnutrition
Score 0,1,2
BMI >20, 18.5-20, <18.5
Weight loss in past 3-6mo <5%, 5-10%, >10%
If ill and no nut intake for 5 days = add 2
score 0 - normal
score 1 - track intake for 3 days then screen at time intervals from then
score 2 - make a plan eg dietician etc
Define acute kidney injury
Rise in serum creatinine of 26 micromol/L or greater within 48 hours.
A 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days.
A fall in urine output to less than 0.5mL/kg/hour for more than 6 hours.
What is uraemia pericarditis
pericarditis caused by build up of toxins as not being excreted eg aki/ckd
ECG pericarditis
Widespread concave ST elevation and PR depression
Reciprocal ST depression and PR elevation in lead aVR (± V1)
sinus tachy
Causes aki
Pre-renal (70%):
- hypovolaemia eg sepsis, dehydration
- renal artery stenosis
- Heart failure
Renal:
- glomerulonephritis
- acute tubular necrosis
- rhabdomyolysis
Post-renal:
- kidney stone
- prostatic hyperplasia
- urinary tract obstruction
Complication of pre-renal aki
acute tubular necrosis
urine sodium levels pre-renal aki
low as kidneys holding onto sodium to preserve volume
Invetsigation pre-renal aki
- hydration assessment
- renal artery doppler if suspect renovascular disease
When to suspect acute tubular necrosis
when there is renal hypoperfusion or a tubular nephrotoxin
Invetsigations for renal aki
Urine dip:
blood and protein suggest glomerulonephritis
normal may suggest ATN
Urine protein:creatinine ratio
nephritic screen
myeloma screen
CK if rhabdomyolysis
normal urine protein:creatinine ratio?
nephrotic?
<15mg/mmol =normal
> 300mg/mmol = nephrotic
Investigations post-renal aki
Bladder scan
Renal tract USS
Drugs that should be stopped in AKI as may worsen renal function
NSAIDs (except if aspirin at cardiac dose e.g. 75mg od)
Aminoglycosides
ACE inhibitors
Angiotensin II receptor antagonists
Diuretics
Drugs that may have to be stopped in AKI as increased risk of toxicity (but doesn’t usually worsen AKI itself)
- Metformin
- Lithium
- Digoxin
Management hyperkalaemia
- IV calcium gluconate to stabilise cardiac membrane
- Combined insulin/dextrose infusion, Nebulised salbutamol
- Removal of K from body: Calcium resonium (orally or enema), Loop diuretics, Dialysis
does aki cause alkalosis or acidosis
acidosis
Define CKD
Presence of marker of kidney damage (e.g. proteinuria) or decreased GFR for > 3 months
Causes of CKD from most to least common
Diabetes (secondary glomerular disease)
Chronic hypertension
Chronic glomerulonephritis
Polycystic kidney disease
Invetsigations CKD
History
Urine dipstick
Renal USS
Renal biopsy if required
When is dialysis indicated CKD
when GFR is <15ml/minute, and there are symptoms or complications of kidney disease
Complications aki
Hyperkalaemia
Fluid overload, heart failure and pulmonary oedema
Metabolic acidosis
Uraemia (high urea) can lead to encephalopathy or pericarditis
Acute tubular necrosis, blood and urine test results
normal serum urea:creatinine ratio would be expected.
On urine tests, sodium levels higher than 40 mmol/, low osmolality, and muddy brown casts would be expected
CKD stages
The G score is based on the eGFR:
G1 = eGFR >90
G2 = eGFR 60-89
G3a = eGFR 45-59
G3b = eGFR 30-44
G4 = eGFR 15-29
G5 = eGFR <15 (known as “end-stage renal failure”)
The A score is based on the albumin:creatinine ratio:
A1 = < 3mg/mmol
A2 = 3 – 30mg/mmol
A3 = > 30mg/mmol
The patient does not have CKD if they have a score of A1 combined with G1 or G2. They need at least an eGFR of < 60 or proteinuria for a diagnosis of CKD.
When to refer CKD to specialist
eGFR < 30
ACR ≥ 70 mg/mmol
Accelerated progression defined as a decrease in eGFR of 15 or 25% or 15 ml/min in 1 year
Uncontrolled hypertension despite ≥ 4 antihypertensives
