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CP3 Medicine > Renal - AKI and CKD > Flashcards

Renal - AKI and CKD Flashcards

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1
Q

Role of renal corpuscle

A

Produces glomerular filtrate

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2
Q

Role of Proximal convoluted tubule

A

Isotonically reabsorbs 2/3 Na+ + H2O

Also absorbs HCO3- + glucose

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3
Q

Role of LH - descending limb

A

Passive transport of H2O by increased medularly osmolarity

Tubular fluid concentrated

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4
Q

Role of LH - ascending limb

A

Reabsorbs 20% Na

Dilutes tubular fl b/c H2O impermeable

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5
Q

Role of DCT

A

Reabsorbs remaining H2O, Na+, HCO3-
Secretes K+
Synthesises HCO3-

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6
Q

Role cortical collecting duct

A

Fine adjustments to [ ]
Principle cells secrete K+
Intercalated cells secrete H+ into lumen + synthesise HCO3- for blood

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7
Q

Role medullary collectign duct

A

Draws H2O + urea out b/c hypertonic interstitium

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8
Q

2’ functions of kidney (3)

A

Secretes EPO (stim erythropoeisis)
Secetes renin to incr BP
Hydroxylation/activation vit D

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9
Q

Anatomical position of kidneys

A

L1-3

Retroperitoneally

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10
Q

What is an AKI

A

Acute decline in GFR over 48hrs

= a sudden reversible deterioration in kidney fct

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11
Q

What are NICE’s req for an AKI to be present (3)

A

UO <0.5ml/kg/hr 6hrs
>50% rise creatinine over 7 days
>26micromol rise creatinine over 48hrs

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12
Q

AKI stage 1

A

Se Creatinine: 150-200% incr
or
25 umol/l incr in 48hr
UO <0.5ml/kg/h 6hr

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13
Q

AKI stage 2

A

Se creatinine 200-300% incr

Or <0.5ml/kg/h 12 hr

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14
Q

AKI stage 3

A

Se creatinine >300% incr

UO <0.3ml/kg/hr 24hr or anuria 12hr

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15
Q

Who is AKI more common in

A

Elderly pt w/ pre-existing CKD, DM, HTN, sepsis or hypovolaemia

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16
Q

What Sx does AKI usually PS with

A

ASYMP

or oliguria

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17
Q

2’ Sx AKI (3)

A

Uraemia –> Vom, pruritis, encephalopathy
Hyperkalaemia
Pulm oedema

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18
Q

How are the causes of AKI split up?

A

Into :
pre renal
renal
post renal causes

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19
Q

What is pre-renal AKI to do with

A

Perfusion

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20
Q

What type of AKI is most common in hospital pt

A

Pre-renal

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21
Q

What are the 2 main causes of pre-renal AKI

A

SHock

Renovascular obstruction

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22
Q

E.g.s of conditions –> shock + pre-renal AKI

A

Hypovolaemic shock - haemorrhage/fl loss
Cardiogenic: CCF, valve disease
Distributive
Sepsis

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23
Q

E.g.s of conditions –> renovsacular obstruction + pre-renal AKI

A

Embolus
Aortic dissection
RAS
Thrombosis

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24
Q

If interuption to blood supply of kidneys is prolonged, what occurs

A

ATN

= Acute tubular necrosis

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25
Urine osm, urine Na + concentrating powers - initial pre-renal AKI
Urine osm = high (>500) Urine Na = low (<25) Concentrating powers = retained
26
Urine osm, urine Na + concentrating powers - ATN
Urine osm = isotonic w/ plasma (<400) Urine Na = high (>40) Concentrating powers = lost
27
What are post-renal AKI's due to ?
Obstruction to outflow urinary tract
28
Where is the blockage often in post-renal AKI?
Ureters
29
E.g.s of conditions --> bladder outflow obstruction + post-renal AKI (4)
Prostatic enlargement Urethral strictures Phimosis / paraphimosis
30
What is the cause of 85% renal AKI?
Acute tubular necrosis (post ischaemic or Dx)
31
Other causes of renal AKI
Interstitial nephritis Glomerular disease Intratubular obstruction Vascular disease
32
Drugs causing ATN
Aminoglycosides Cephalosporin Radiological contrast mediums NSAIDS
33
Toxins causing ATN
Heavy metal poisoning Myoglobinuria HUS
34
Appearance kidneys ATN
Enlarged Pale Markings are lost
35
Where does ischaemic damage start in ATN
In cortex
36
Which parts of the nephron are most commonly affected by ATN
PCT | Ascending LH
37
What does myoglobinuria follow
Rhabdomyolysis
38
Appearance urine myoglobinuria q
Dark urine
39
Cause HUS in children
Diarrhoeal illness b/c verotoxin prod by E.Coli 0157
40
Cause HUS adults
FOllowing URTI
41
Sx HUS
Thrombocytopenia --> purpura Haemolyis ATN
42
Prognosis - HUS in kids
Usually recover in a few weeks
43
Prognosis HUS in adults + Mx
Poor | Mx supportively w/ dialysis
44
What is interstitial nephritis caused by
Abx Diuretics Allopurinol PPIs
45
How does interstitial nephritis differ from ATN
Damage bypassses BM to cause damage to interstitium
46
Mx interstitial nephritis
Withdraw Dx | Short course PO steroids
47
Ix AKI/CKD
``` Obs incl BP O/E - palpable bladder Bloods - FBC, U+E, HCO3- PO4-, CRP, clotting, CK Nephritic screen ABG Urine Dip + MCS ECG Renal USS ```
48
What is included in a nephritic screen? (6)
``` ANCA + antiGBM ANA + dsDNA + complement studies Immunoglobulins Se electrophosis RF Hep B/C - MCGN ASO (post streptococcal) ```
49
Common electrolyte abnormalities in AKI (5)
``` Uraemia Hyperkalaemia Hypernatraemia Met acidosis Hypokalaemic/hypophosphataemia (> in CKD) ```
50
Causes hyperkalaemia (5)
AKI/CKD Drugs - K sparing diuretics, ACEi, NSAIDs Acidosis Addisons/tumour lysis syndrome/burns
51
Causes of pseudohyperkalaemia (3)
haemolysis incorrect order blood draw sample taken from drip aarm
52
Hyperkalaemia - changes on ECG (3)
Tall tented T waves Widened QRS Flattened P waves/prolonged PR interval
53
If hyperkalaemia is unTx, what cardiac condition can develop
VF/TachyC
54
Mx K+ >6.5
Continuous ECG Stabilise heart: 10ml 10% Ca gluconate IV 50ml 50% glucose + 10U ACTRAPID insulin large vv 30 mins +/- 10mg salbutamol nebs If pH <7.2 - NaHCO3- IV Tackle underlying cause
55
Stage 1 CKD
eGFR 90+ | Normal kidney fct but urine findings/structural abnorm or genetic traits that point to kidney disease
56
Stage 2 CKD
60-89 Mildly reduced kidney fct + other findings pointing to kidney disease
57
Stage 3 CKD
30-59 | Moderately reduced kidney function
58
Stage 4 CKD
15-29 | Severely reduced kidney function
59
Stage 5 CKD
<15 | V severe or established RF
60
Aetiology CKD (8)
``` DM HTN Chronic glomerulonephritis Chronic pyelonephritits Obstructive uropathy Renovascular disease Dx - l term NSAIDs PKD ```
61
Sx CKD (7)
``` Asymp till advanced Polyuria/nocturia Restless leg syndrome Fatigue/anorexia Sexual dysfunction Nausea + pruritis Pedal oedema + pulm oedema ```
62
Signs CKD (3)
Pallor HTN/fl overload Pericardial rub
63
Ix CKD (9)
``` Cockcroft Gault eq Bloods: FBC, U+E. LFT, Ca, PO4, PTH, glucose Urinalysis +MCS 24hr protein/creatinine clearance CXR Renal USS ```
64
Conditions who should be offered testing for CKD (7)
``` DM HTN CV disease Structural renal disease/stones/BPH FHx Haematuria Multisystem disease ```
65
Mx CKD (4)
ACEi = 1st line Aim for BP <130/80 Start statin + low dose aspirin (CV prevention)
66
2nd line Mx CKD (3)
Recombinant EPO Ca/Vit D K+ restriction
67
How does renal anaemia occur
Kidney norm secretes EPO in response to hypoxia | CKD - loses ability to secrete EPO partially --> Anaemia
68
Mx renal anaemia
Recombinant EPO added to dialysis
69
How does renal bone disease occur
Kidneys norm prod 1-a-hydroxylase Which activates Vit D Which increases Ca Hence if low --> osteomalacia --> osteopenia
70
Tx of renal bone disease (3)
Restrict dietary phosphase Phosphate binders (calcichew) AdCal (Ca + Vit D)
71
Haemodialysis - how often do pt have to have it
4hrs 3xw
72
Main issue w/ haemodialysis
Haemodynamic instability during dialysis
73
What is haemofiltration
Variant of dialysis | Blood = continuously filtered across highly permeable membrane
74
What is peritoneal dialysis
Pt instills 2L isotonic/hypertonic solution --> peritneal cavity Equilibrates w/ blood in peritoneal capillaries Fl = drained after 2hrs, 3-4times a day
75
Risk peritoneal dialysis
Infection | Peritonitis
76
Annual % mortality dialysis
20%
77
Common complications of dialysis (5)
``` Infection CVD Renal bone disease/anaemia Bleeding tendencies Incr risk renal malignancy ```
78
Complications - renal transplant (4)
Operative Rejection Ciclosporin/lacrolimus toxicity Infection/malig b/c immunosuppression
79
Prognosis Renal transplant
80-95%

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