RENAL AKI Flashcards Preview

T year LOBs medicine > RENAL AKI > Flashcards

Flashcards in RENAL AKI Deck (81):
1

what are symptoms of uraemia?

- nausea
- vomiting
- fatigue
- weight loss
- pruritus
-mental changes
- fits

2

what Pre-renal conditions cause AKI?

Hypovoeliama: can be dehydration or haemorrhage

hypotension: Cirrhosis or septic shock

Low CO: cardiac shock or heart failre

Renal artery stenosis

3

What renal conditions cause AKI?

Glomerulonephritis
Systemic disease
acute tubular necrosis
interstitial necrosis

nephrotoxicity due to drugs

Contrast

Rhabdomyolysis

4

What drugs are nephron-toxic?

ACE inhibitors
metformin
NSAIDS
Diuretics
Statins
Vancomycin/ gentamycin

5

what are post renal causes of AKI?

Renal calculi
BPH
Tumour

6

what metabolic changes are seen in renal injury?

Raised creatinine
Raised Urea
A rise in urine osmolality
Hyperkalaemia
metabolic acidosis
hyponatraemia
Anaemia (less EPO)
Low Vit D

7

what investigations can be done in AKI?

- insert a urethral catheter to monitor fluid balance
- urinanalysis
- U and Es
FBC
ultrasound

8

what is the management of AKI?

- Manage hyperkalaemia
- Diuretics for water overload
- antibiotics for any infection
- Stop any nephrotoxic drugs
- Haemodialysis or Haemofiltration

9

What is target Hb in acute renal failure?

10.5-12

10

how do you manage anaemia in AKI?

- check it's not iron/B12 deficiency
- Ferritin <200 give IV iron
- Give EPO

11

How do you assess if the patient is volume depleted?

- postural hypotension
- decreased JVP
- increased Pulse
- skin turgor decreased
- Dry mucous membranes

12

what are indications for acute dialysis?

Persistant hyperkalaemia
refractory pulmonary oedema
symptomatic uraemia
Severe metabolic acidosis
Poisoning

13

what ECG changes are seen in hyperkalaemia?

- Peaked T waves
- flattened P waves
- increased PR interval
- widened QRS

14

what is the management of hyperkalaemia?

10ml 10% calcium gluconate
50ml 50% glucose and insulin

15

what are symptoms of chronic kidney disease?

- 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

why are people with chronic renal failure at risk of bone disorders?

- The kidneys carry out 1 hydroxylation for vit D and therefore calcium absorption
Low calcium will stimulate PTH causing calcium release from bone

17

why do people with chronic renal disease get hypernatraemia?

Low GFR means low flow through juxtaglomerular apparatus. RAAS is stimulated

18

what are causes of CKD due to inherited and congenital conditions?

- polycystic kidney disease
- tuberous sclerosis
- cystinosis

19

what is the staging for CKD?

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

what are common causes of chronic kidney disease?

Diabetes Melitus
hypertension

21

what are possible complications of chronic kidney disease?

Cardiovascular disease
Renal osteodystrophy
Fluid (oedema)
HTN
Electrolyte disturbances
Anaemia
Leg restlessness
Sensory neuropathy

22

what are the symptoms of autosomal dominant polycystic kidney disease?

- loin pain
- haematuria
- abdominal discomfort
- berry aneurysms
- uraemia
- renal calculi

23

what is stage 1 hypertension?

140/90 or higher in clinic.
ABPM average 135/85

24

what is stage 2 hypertension?

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