Renal Flashcards
(41 cards)
Definition of AKI
> 26umol/L increase in creatinine in 48hrs
<0.5mls/kg/hour of urine output
50% increase in creatinine in 7/7
Causes of systemic vasodilation which could cause an AKI.
SEPSIS
Causes of renal vasoconstriction in AKI
ACEi
ARB
hepatorenal syndrome
What monitoring a patient. What should you check on bloods and on examination
Pulmonary Oedema
K+
Sodium and urea (volume)
Fluid resuscitation mx for AKI
500mLs over 15 min of 0.9% saline
2L before specialist help.
Drugs to stop in AKI
NSAIDS
Diuretics/k+ sparing drugs
Gentamycin and aminoglycasides
ACEi and ARB
Most common causes of CKD
Diabetes and hypertensio
less common causes of ckd
glomerulonephritis
Autoimmune disease
PCKD and ADPCKD
NSAIDs and Lithium (drugs) + PPI
monitoring of CKD is done through
eGFR 90, 60, 45, 30, 15
Albumin to creatinine ratio
Common problems and ckd presentations
low appetite faitgue nausea itching OEDEMA
5 complication in CKD
cardiac failure anaemia metabolic bone disease/mineral bone disease oedema Acidosis
Management of acidosis in CKD
consider bicarbonates (sodium bicarb IV) if GFR <30 Be aware of fluid overload because of Na addition
Management of anaemia in CKD
EPO. EPO won’t work if Fe deficient so test and treat.
Oedema management
Loop Diuretics
Loop + thiazide = fucking strong
furosemide bendroflumethiazide
Fluid restriction to 1L/day and strict fluid and weight monitoring
Bone mineral pathology in CKD
Bad clearance of PO4. Low production of D3.
High PO4 and low Ca.
Causes 2ndary hyperparathyroidism. Which can then cause osteoporosis
2ndary can develop into tertiary if PT hyperplasia. Then massive PTH and normal to raised Ca
Management of bone mineral disease in CKD
If PO4 >1.5mmol/L. Give phosphate binders (calcium acetate first line)
Vitamin D supplements (colecalciferol)
Adcal d3 is always your friend.
A patients presents to A&E with confusion, abdominal pain and reduced urine output following 5 days of diarrhoea.
1) What is the most likely diagnosis. What 3 other signs/symptoms might you expect with initial examination and investigations.
2) What organism and toxin commonly causes this disease
3) Triad associated with this disease
4) 3 Aspects of management
5) 2 Drugs that increase the risk of this disease
1) Haemolytic uraemia syndrome. Haematuria, Hypertension. Bruising. lethargy, irritability
2) E. Coli - produced shiga toxin. (also produced by shigella toxin but less common.
3) Thrombocytopenia. Haemolytic anaemia. AKI
4) BP management. Blood transfusions. Dialysis
5) Broad spectrum antibiotic. Loperamide
Patient with an AKI has a serum urea of 16 and a serum creatinine of 190 (baseline of 95).
What is the most likely cause of the AKI
Any pre-renal cause
Raised urea: creatinine ratio = pre-renal cause of AKI
A patient is acidotic, with hyperkalaemia, hypochloraemia
1) Diagnosis?
2) Urine pH?
3) 2 Causes
1) Type 4 renal tubular acidosis
2) Low
3) Addisons disease. ACE-I
1
a) What is the cause of type 1 renal tubular acidosis
b) What are the bloods
2
a) What is the cause of type 2 renal tubular acidosis
b) What are the bloods
3) How to manage both
1a) Distal tubule unable to excrete hydrogen
b) Hypokalaemia. acidosis
2a) Proximal tubule can’t reabsorb bicarb
b) Hypokalaemia. High urine pH
3) Oral bicarbonate
4 Aspects of nephritic syndrome
High bp
haematuria
renal impairment
?proteinuria
1) Causes of nephritis
2) Most common cause in children/young people
3) What should you ask a 6 yo with dark urine/haematuria
1) SLE, Post-strep, IgA, vasculitis, Anti-GBM
2) IgA
3) If they have had a recent throat infection
Presentation of nephritis
Haematuria Fluid excess - oedema and ascites Lethargy Hypertension Low urine output
Management of IgA nephropathy
Low salt diet
ACE-I
Corticosteroids may be needed
