RENAL Flashcards
(36 cards)
AKI criteria - any fo the following ?
- Rise serum creatinine of 26 micromol/litre or greater within 48 hours
- 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days
- Urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults and more than
Management of hyperkalaemia (>6.5mmol or ECG changes)?
-IV calcium gluconate to stabilise myocardium
-Insulin/dextrose infusion
-Nebulised salbutamol may be given to lower serum potassium
What are the principles of management in hyperkalemia?
- Stabilisation of cardiac membrane (IV calcium gluconate)
- Short term shift of potassium from ECFR to ICF
-Combined insulin/dextrose infusion
-Nebulised salbutamol - Rmeoval of potassium from the body
-Calcium resonium (orally or enema is more effective )
-Loop diretics
-Dialysis
When is dialysis considered in hyperkalemia?
-Patients with AKI and persistent hyperkalemia
-Heamofiltration/ heamodialysis
What management in hyperkalemia lowers the total body potassium?
-Calcium resonium
-Loop diuretics
-Dialysis
Define contrast media nephrotoxicity
-25% increase in creatinine occuring within 3 days of contrast media
-Occurs 2-5 days after administration
What are the risk factors of contrast induced nephrotoxicity?
-Renal impairemtn (particulary diabetic)
-Age >70
-Dehydration
-Cardiac failure
-Nephrotoxic drug iuse
Procedures that cause contrast induced nephtopathy?
-CT with contrast
-Coronary angiogrpahy/ PCI
What can be given to reduce a patient risk of developinbg contrast induced nephropathy?
IV 0.9% sodium chrolide 1ml/kg/hour for 12 hours pre and post procedure (causes volume expansion)
-Also evidence for isotonic sodium bicarbonate
Investigation with AKI?
- Urinalysis in all patients
- RENAL ULTRASOUND if no identifiable cause for AKI or risk of urinary tract obstruction - wihtin 24 HOURS
Chronic kidney disease anaemia is mainly due to what?
-Reduced erythropoietin levels
What kind of anaemia is usually caused but CKD?
normochromic normocytic anaemia
When does anaemia become most apparent in patients with CKD?
- GFR <36 ml/min
-If GFR >60 other causes of anemia should be considered
What other factors contribute to anaemia in CKD?
-Reduced iron absorption
-Reduced erythropoiesis die to toxic effects of uremia on bone marrow
-Anorexia/nausea due to uremia
-Reduced red cell survival (haemodialysis)
-Blood loss due to capillary fragility
-Stress ulceration
Why is there reduced absorption of iron in CKD?
1.-Hepcidin levels are increased due to inflammation and reduced renal function
-this leads to a decrease in iron absorption from gut and impaired release of iron from macrophages and hepatocytes
-Iron for erythropoiesis is reduced
- In metabolic acidosis iron cannot be converted into its absorbable form in the duodenum so there is reduced iron abosprtion
What is target haemoglobin in patients with anaemia in CKD?
10/12g/dl
What is the management of anaemia in CKD?
-Determination and optimisation of iron status should be carried out prior to administration of erythropoiesis-stimulating agents (ESA)
What is the management of pateitns who are not on ESA or haemodylasis with anameia in CKD?
-Oral iron
-If target Hb is not reached within 3 months swtich to IV iron
What ESA offered to patients with anaemia in CKD ?
-Erythropoietin and darbepoetin
-Should be used in patients who “will benefit in terms of QOL and physical function”
What iron treatment should be given to patients on ESA or haemodialysis with anaemia in CKD?
-IV iron
What are two types of ADPKD?
ADPKD type 1
-85%
-Chromosome 16
-present with renal failure earlier
ADPKD type 2
-15%
-Chromosome 4
What is the most common inherited cause of kidney disease?
ADPKD
What investiagtion for relatives wiht ADPKD?
Abdominal US
What is diagnostic criteria of ADPKD in patients with family history?
-2 cysts (unilateral or bilateral) if <30
-2 cysts in both kidneys if 30-59
-Four cysts in both kidneys if >60
