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2a RRS > renal > Flashcards

renal Flashcards

(52 cards)

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1
Q

Treatment of Hyperkalemia

A

IV insulin and Glucose
since insulin stimulates uptake of Glucose
drives K+ IN

dialysis or haem filter

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2
Q

how to treat pul oedeama

A

diuretics - furosemide

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3
Q

what are CFs of AKI

A 
oliguria/anuria
pruritis
uraemia - confusion
HTN
fluid overload - oedema
signs of dehrydartion /urin retention
anaemia and pulm oedema secondary to vol overload = breathless
arrythmias (as high K+)
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4
Q

RFs forAKI

A 
diabetes
sepsis
low fluid intake/ high fluid loss
heart failure
CKD
liver disease
NSAIDs and ACEi
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5
Q

how to dignose AKI in terms of creatine etc

A

rapid change in urea and creatinine
increase in creatinine over 28umol/L (48hrs)
increase in creatine over 50% of baseline (7days)
urine output less than 0.5 ml/kg/hr >6 consec hours
(ONE OF THESE 3)

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6
Q

Prevention of AKI

A

monitoring drugs they are taking, temporarily stopping them if they have D and v
ensure patients in hospital are well hydrated use fluid volume charts
Med review if D and V

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7
Q

complications of AKI n how treat each

A

Hyperkalemia (insulin or glucose=drives K+ IN cell
calcium gluconate = cardio protective - calcium is inverse relationship w K+)
edema - diuretics - furosemide (loop diuretic)
uremia
acidosis - IV Na Bicarb (dont use in vol overload = pulm oedema)

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8
Q

What is creatinine and why is it used in Dx

A

its a muscle breakdown product that is filtered freely in the kidney and not reabsorbed so gives indication of kidney filtration levels. elevated serum creatinine suggest reduced filtration

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9
Q

what does Acute kidney injury mean

A

Spectrum of kidney disease ranging from mild improvement to full kidney failure requiring RRT

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10
Q

causes of AKI

A

commonest are ischemia, sepsis, nephrotoxins
Pre renal - commonest cause (70%)
renal-
Post renal causes- least common

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11
Q

3 diff types of aki and basic reason for each

A

pre renal - hypoperfusion
renal - struct damage
post renal - obstruction

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12
Q

ECG changes of hyperkalemia

A

tall tented T wave
absent P wave
increased PR interval
wide QRS

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13
Q

what are the complications of uremia in AKI

A

confusion , coma

neuropathy,

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14
Q

Indications to refer AKI to nephrologist

A

Hyperkalemia

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15
Q

WHat are indications for dialysis in AKI

A

Fluid overload signs and symptoms, JVP, Oedema , nocturnal Dysnpnoea
or Anuria
Hyperkalemia
metabolic acidosis
Uraemic complications like encephalopathy
drug overdose

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16
Q

Managment of AKI

pre renal

A

if sepsis = ABX
if not
correct fluid / electrolyte imbalance w fluid resus

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17
Q

management of aki

renal

A

may need dialysis or refered to nephrologist

treat underlying Cx

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18
Q

Managment of AKI

post renal

A

catherise

monitor urine output

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19
Q

management of AKI general

A

stop NSAIDs and ACEi and genamicin ABX
(= NEPHROTOXIC drugs)
treat underlying cause

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20
Q

Dx what do u always ask about in AKI

A

DRUG CHANGES

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21
Q

causes of post renal AKI

Study These Flashcards
A

outflow obstruction
= stones malig and clots
increase p decreases p gradient so GFR decreases

22
Q

which malig in post renal AKI most likely cause of outflow obstruct

Study These Flashcards
A

bladder ureter and prostate

23
Q

causes of renal AKI

Study These Flashcards
A 
within kidney  structual damage
Cx= acute tubular necrosis
SLE 
NSAIDs
sustained hypoperfusion - prerenal AKI
vasular - ischeamic, high BP
glomerulonephritis
24
Q

causes of pre renal AKI

Study These Flashcards
A 
HYPOPERFUSION
so hypovolaemic shock
renal artery stenoisis
sepsis
dehydration - NAUSEA N VOM
Burns
haemmorage
NSAIDs and ACEi
25
how does NSAIDs and ACEi cause decrease in GFR
postaglandins = afferent dilation angiontensin 2 = efferect constriction === both increase GFR HENCE if blocker GFR deceaseas
26
Dx of AKI
``` ECG - hyperkalaemia rapid rise in urea and creatinine (see diff card) ask about drug changes bladder outflow? palpate bloods - fbc = anaemia urine blood and culture - excl infection CXR - pul oedema US - size = small in CKD ```
27
what is CKD
impsaired renal function for over 6 months based on abnormal structure or function or GFR<60ml
28
what is chronic kidney disease, time to become chronic
Renal impairment for more than 3 Months
29
how is chronic kidney disease staged and what symptoms are found at each stage
EGFR stage 1 > 90 just has risk factors stage 2 = 60-90 proteinuria stage 3 = 30-59 still asymptomatic, N and V stage 4 = 15-30 this is when symptoms usually start to show end stage renal failure <15 - needs RRT at this stage
30
causes of CKD
``` primary glomerulonephritis VITAMIN C V- vascular - HTN, renal artery stenosis, vasculitis Infective -polyneophritis Trauma Autoimmune - SLE, DM Metabolic Idiopathic Neoplastic ``` Congen - polycystic kidney
31
CFs of CKD
``` asmpt to moderate anorexia N&V fatigue periph oedema LUTS anaemia (less EPO) prutitis easy bruising polyuria ```
32
why would CKD cause anaemia?
less EPO
33
Rf for CKD
HTN DM atherosclerotic renal vasc disease women african
34
pathophsyiology behind CKD
HYPERFILTRATION HTN - BV walls thicken = less oxygen nd blood = ischaemic injury to glomerulus macrophages and foam cells secrete growth factors - TNF-beta1 - mesengial cells to mesangioblasts secrete extra cell matrix == GLOMERULOSCLEROSIS cant filter blood
35
how does diabetes cause increase risk of CKD
XS glucose sticks to proteins in efferent arteriole = stiff and narrow (HALINE SCLEROSIS ) so increased p within glomerulosis = HYPER FILTRATION
36
complications of CKD
``` FLASH BACK Fluid overload (l) Acidosis Sympotoms of ureamia (CNS encephalopathy - asterix confusion etc) HTN ``` Bone disease - phosphate retention = hypOcalcaemia. less vit D activaation = less ca absorbed Anaemia (less EPO) = pallor lethargy CVS dis - pericaditis, pericardial rub, cardiomegaly K increase (hyperkalcemia = AF)
37
Dx of CKD
``` ECG - hyperkalaemia urinalysis - haematuria proteinuria bloods - INCREASED urrea and creatinine USS - SMALL KIDNEYS***** eGFR - LOW low calcium high PTH high phosphate high renin creatinine clearance test = estomates eGFR ```
38
``` Mx of CKD #conservative ```
treat reversible causes - stop smoking, excersie diet etc stop nephrotoxic drugs (NSAIDs ACEi) treat complic - bone ; vit D , anaemia etc maintain optimal bp - Diet, avoid high phosphate food, Potassium restrictions
39
Mx of CKD | stage 1 to 4
Main cause of death is CVD | so ACEi or ARB plus statins plus diuretics plus CCB if needs be
40
Mx of CKD end stage
transplant/dialysis = RNEAL REPLACEMENT THERAPY | dialysis - peritoneal or haemodialysis
41
what is peritoneal dialysis
metabolic waste diffuses dwon gradient into dialysis fluid via peritoneal capillaries
42
what is haemoialysis
hospoital or home - | Hypotension, nausea infection risk
43
whos is screened for Chronic kidney disease
``` screen at risk patients Diabetes Hypertension CVD BPH Recurrent UTI Family history of ESRD Congenital kidney disease like PCKD ```
44
how is screening for Chronic kidney disease done
Albumin creatinine ratio urinalysis serum creatinine
45
acute renal failure vs chronic | size of kidneys
``` acute = normal chronic = small ```
46
acute renal failure vs chronic | diabetes?
not in acute | assos with chronic
47
acute renal failure vs chronic | anaemia assos?
acute NO | chronic YES normocytic normochromic
48
acute renal failure vs chronic | which has high BP
chronic | =low in acute
49
acute renal failure vs chronic | time frames
acute - rapid change in urea/creatine | chronic - gradual sympotom onset
50
acute renal failure vs chronic | oliguria?
acute - yes | chronic - only later stage
51
acute renal failure vs chronic | cns involvment?
``` Acute = none chronic = late stage as urea increases ```
52
acute renal failure vs chronic | sympotms description
acute - shock like | chronic - like serious extensive disease

2a RRS (26 decks)

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