RENAL AKI Flashcards
(81 cards)
1
Q
what are symptoms of uraemia?
A
- nausea
- vomiting
- fatigue
- weight loss
- pruritus
- mental changes
- fits
2
Q
what Pre-renal conditions cause AKI?
A
Hypovoeliama: can be dehydration or haemorrhage
hypotension: Cirrhosis or septic shock
Low CO: cardiac shock or heart failre
Renal artery stenosis
3
Q
What renal conditions cause AKI?
A
Glomerulonephritis
Systemic disease
acute tubular necrosis
interstitial necrosis
nephrotoxicity due to drugs
Contrast
Rhabdomyolysis
4
Q
What drugs are nephron-toxic?
A
ACE inhibitors metformin NSAIDS Diuretics Statins Vancomycin/ gentamycin
5
Q
what are post renal causes of AKI?
A
Renal calculi
BPH
Tumour
6
Q
what metabolic changes are seen in renal injury?
A
Raised creatinine Raised Urea A rise in urine osmolality Hyperkalaemia metabolic acidosis hyponatraemia Anaemia (less EPO) Low Vit D
7
Q
what investigations can be done in AKI?
A
- insert a urethral catheter to monitor fluid balance
- urinanalysis
- U and Es
FBC
ultrasound
8
Q
what is the management of AKI?
A
- Manage hyperkalaemia
- Diuretics for water overload
- antibiotics for any infection
- Stop any nephrotoxic drugs
- Haemodialysis or Haemofiltration
9
Q
What is target Hb in acute renal failure?
A
10.5-12
10
Q
how do you manage anaemia in AKI?
A
- check it’s not iron/B12 deficiency
- Ferritin <200 give IV iron
- Give EPO
11
Q
How do you assess if the patient is volume depleted?
A
- postural hypotension
- decreased JVP
- increased Pulse
- skin turgor decreased
- Dry mucous membranes
12
Q
what are indications for acute dialysis?
A
Persistant hyperkalaemia refractory pulmonary oedema symptomatic uraemia Severe metabolic acidosis Poisoning
13
Q
what ECG changes are seen in hyperkalaemia?
A
- Peaked T waves
- flattened P waves
- increased PR interval
- widened QRS
14
Q
what is the management of hyperkalaemia?
A
10ml 10% calcium gluconate
50ml 50% glucose and insulin
15
Q
what are symptoms of chronic kidney disease?
A
- confusion and fits if there is severe uraemia
- hypertension
- heartfailure
- nocturia, polyuria, salt and water retention
- oedema
- polyneuropathy
- amenorrhoea
- anorexia
- weight loss
- vomiting
- diarrhoea
- bruising
- pigmentation
16
Q
why are people with chronic renal failure at risk of bone disorders?
A
- The kidneys carry out 1 hydroxylation for vit D and therefore calcium absorption
Low calcium will stimulate PTH causing calcium release from bone
17
Q
why do people with chronic renal disease get hypernatraemia?
A
Low GFR means low flow through juxtaglomerular apparatus. RAAS is stimulated
18
Q
what are causes of CKD due to inherited and congenital conditions?
A
- polycystic kidney disease
- tuberous sclerosis
- cystinosis
19
Q
what is the staging for CKD?
A
1- GFR >90. evidence of kidney damage 2- GFR 60-89 3a- GFR 45-59 3b- GFR 30-44 4. 15-29 5. >15
20
Q
what are common causes of chronic kidney disease?
A
Diabetes Melitus
hypertension
21
Q
what are possible complications of chronic kidney disease?
A
Cardiovascular disease Renal osteodystrophy Fluid (oedema) HTN Electrolyte disturbances Anaemia Leg restlessness Sensory neuropathy
22
Q
what are the symptoms of autosomal dominant polycystic kidney disease?
A
- loin pain
- haematuria
- abdominal discomfort
- berry aneurysms
- uraemia
- renal calculi
23
Q
what is stage 1 hypertension?
A
140/90 or higher in clinic.
ABPM average 135/85
24
Q
what is stage 2 hypertension?
A
clinical blood pressure 160/100 or higher
ABPM average 150/95 or higher
25
what is severe hypertension?
180/110 or higher
26
what is the blood pressure target for people under 80?
140/90
27
what is the blood pressure target for people over 80?
150/90
28
what is the management of hypertension in people under 55 years?
1. ACE inhibitor or Low cost ARB
2. Ace inhibitor + Calcium channel blocker
3. Ace inhibitor+ calcium channel blocker + thiazide like diuretic
4. Ace inhibitor+calcium channel blocker + thiazide diuretic + alpha/beta blocker
29
what is the management of hypertension in someone over 55 or block African/ caribean?
1. Calcium channel blocker OR thiazide like diuretic
2. Ace inhibitor + calcium channel blocker OR thiazide diuretic
3. Calcium channel blocker + ACE inhibitor + thiazide like diuretic.
30
what are some common causes of hypertension?
- renal disease
- vascular disease
- conns syndrome
- cushings syndrome
- phaechromocytoma
- pre eclampsia
- primary
31
what are some effects of hypertension?
- atherosclerosis
- aneurysm
- aortic dissection
- haematuria
- pulmonary oedema
- MI
LVH
- vascular dementia
- haemorrhages
- exudates
32
what are some symptoms of hypertension?
- headache
- visual changes
- fatigue
- confusion
- irregular heartbeat
- haematuria
- nose bleed
33
what are signs of alkalosis?
- confusion
- hand tremor
- light headed
- muscle twitches
- nausea
- numbness
34
what is a ddx for metabolic acidosis?
severe sepsis, shock, DKA, pancreatic fistula, lactic acidosis, ethanol/aspirin poisoning, renal failure, renal tubular acidosis
35
what are ddx of metabolic alkalosis?
excessive thiazide use, vomiting,over use of alkaline antacids and hypokalaemia
36
what are ddx for respiratory acidosis?
airway obstruction, COPD, aspiration, strangulation, respiratory centre depression, pulmonary disease, pneumonia, flail chest
37
what is respiratory alkalosis?
hypoxia, severe anaemia, pulmonary disease, PE, increased rep drive, hepatic failure, hyperventilation
38
what are signs of intravascular volume depletion?
- hypotension, shock, hypoperfusion, AKI, tachycardia, decreased UO, poor cap refill, orthostatic hypotension
39
what are signs of fluid overload?
- impaired oxygenation
- oedema
- hypertension
- organ congestion
- increased JVP
40
what are causes of hyperkalaemia?
- renal failure
- activation of alpha adrenoreceptors
- haemolysis
- thrombocythaemia
- ischaemia
- rhabdomyolysis
- potassium sparing diuretics, ACE inhibitors
- addisons disease
- metabolic acidosis
41
what is the effect of aldosterone on potassium?
increases excretion
42
what are causes of hypokalaemia?
- activation of beta 2 adrenoreceptors
- loop diuretics
- thiazide diuretics
- vomiting
- diarrhoea
- cushings syndrome
- conns syndrome
- alkalosis
43
what are causes of hyponatraemia?
- hyperglycaemia
- diuretics
- vomit and diarrhoea
- addisons
- ectasy
44
what are causes of hypernatraemia?
- diuretics
| - diabetes insipidus
45
what ECG changes happen with hyperkalaemia?
- flattening of P waves, tall tented T waves, wide QRS
46
what are ECG changes in hypokalaemia?
flat T waves, ST depression, prominent U wave
47
how do you manage volume depletion?
- give 0.9% saline
- colloid solutions like albumin can be used
- if mild give oral
48
what is the management of hyponatraemia?
- vasopressin antagonists
- if hypovolaemic: give NaCl and stop diuretics.
euvolaemic- restrict fluid, stop diuretics. give thyroxin and consider sodium and demeclocycline
49
what is the management of hypernatraemia?
IV dextrose
50
what is the management of hyperkalaemia?
- 10% 10ml calcium gluconate
| - 50%dextrose with 10 units of insulin
51
what is the emergency management of hypokalaemia?
- <2.5- give max IV dose
| 2. 5-3 take ECG and give IV 80-120mmol over 24 hours
52
how would you investigate a suspected UTI?
- clinical history
- MSU sample
- urine dip stick
53
what is the management of a UTI?
- three day course of trimethoprim
| 5 day course of nitrofurantoin
54
what are the rifle stages of AKI?
Stage one: serum creatinine rise of>26,4
Stage two: 2-3x increase in creatinine
Stage three: creatinine >354
55
what are the risk factors for acute renal failure?
- elderly
- peripheral arterial disease
- CKD
- ACE inhibitors, NSAIDS, aminoglycosides
- intraperitoneal surgery
- liver failure
- diabetes
- hypertension
- heart failure
- sepsis
- hypovalaemia
- rhabdomyolysis
56
who is at high risk of developing hypertension?
- family history
- obesity
- sodium high diet
- long term alcohol
- low birth weight
- black africans
57
what is the pathology behind accelerated hypertension?
- there is vascular fibrinoid necrosis and loss of precapillary arteriolar autoregulation.
after 180/110 autoregulation control is lost
58
what are the three possible criteria for diagnosing AKI?
- UO: <0.5mg/kg/hour
- 50% or greater rise in serum creatinine
- rise in creatinine of 26 in 48 hours
59
what is the urine sodium levels in prerenal causes of AKI?
<20 as the kidneys are still working well enough to resorb it
60
what are the indications for dialysis?
```
Acidosis <7.2
Electrolytes K>7
Ingested toxins (barbiturates, lithium, alcohol, salicylates, theophylline
Oedema
Ureaemia
```
61
what are the diagnostic criteria for CKD?
- impaired renal function for over 3 months
| - GFR <60
62
What are causes of CKD?
- glomerulonephritis
- diabetic nephropathy
- chronic pyelonephritis
- adult PKD
- HTN
63
what does the EGFR using modification of diet in renal disease consider?
- C: serum creatinine
- A: age
- G: gender
- E: ethnicity
64
what is key in stage 3 CKD?
- PTH levels start to raise and there is low vit D.
65
what are features of autosomal dominant polycystic kidney disease?
- hypertension
- UTI
- abdo pain
- renal stones
- haematuria
- CKD
66
what is nephrotic syndrome a triad of?
- proteinuria >3g/24 hr
- hypoalbuminaemia
- oedema
67
what are signs of nephrotic syndrome?
- frothy urine
- high cholesterol
- hypercoaguable
- oedema
68
what are causes of nephrotic syndrome?
- diabetic nephropathy
- SLE
- sjogrens
- multiple myeloma
- vasculitis
69
what is minimal change disease?
Affects children causing nephrotic syndrome
| Foot process death
70
what is focal segmental glomerulisclerosis?
there is dead foot processes and scarring.
| Causing nephrotic syndrome in adults
71
what are causes, typically in children, of nephritic syndrome?
- IgA nephropathy, post streptococcal glomerulonephritis, haemolytic uraemic syndrome, henoch schonelein purpura
72
when does post strep glomerulonephritis occur?
around 7 days after having a strep a infection
73
when does IgA nephropathy happen causing glomerulonephritis?
- 1-2 days after a URTI
74
what is henoch schonelein purpura?
A continuation of IgA nephropathy where it isn't just the kidneys affected but get vasculitis everywhere
75
what are causes of glomerulonephritis in adults?
good pastures syndrome
SLE
rapidly progressive glomerulonephritis
76
what are the investigation findings in goodpastures syndrome?
- IgGs against the basement membrane
| - crescent cells
77
what are investigations findings of acute tubular necrosis?
- muddy brown RBC Cast
| - urinary sodium over 20
78
how is hypertension management different in diabetic patients?
- first line is always ACE inhibitors
| - beta blockers should be avoided
79
what are the targets in diabetics for BP?
- if end organ damage: 130/80
| no end organ damage: 140/80
80
what is responsible for a high anion gap?
K: ketones (DKA, alchol)
U- uraemia; renal failure
Lactate- shock, hypoxia, burns, metformin
T- toxins; salicylates or methanol
81
what calcium hydroxylation takes place in the kidney?
1 alpha
