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Therapeutics > W11 Acute and Chonic Kidney Disease > Flashcards

W11 Acute and Chonic Kidney Disease Flashcards

(49 cards)

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1
Q

what is glomerular filtration rate

A

rate at which the glomerulus is filtering the blood to form the filtrate

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2
Q

what is the GFR for males

A

90 - 140 ml/min

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3
Q

what is the GFR for females

A

80-125ml/min

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4
Q

what criteria does the substance used to measure GFR need to fufill

A

completely filtered
not re-absorbed
not secreted
not metabolised by the nephron

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5
Q

why is inulin not used even though it meets all the criteria

A

it is not practical as it requires an infusion into the blood

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6
Q

what substance do we use

A

creatinine clearance is measured

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7
Q

what is creatinine

A

it is a chemical waste molecule that is generated from muscle metabolism

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8
Q

what is creatinine produced from

A

creatine which is a molecule of major importance for energy production in muscles

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9
Q

how is creatinine excreted

A

removed from the circulation by filtration and excrted in urine

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10
Q

What does a rising creatinine level indicate

A

kidneys not functioning to their full ability

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11
Q

what potential problem can lack of kidney function cause

A

loss of nutrients from the body

failure to remove toxins

affect drug treatments

affect blood pressure

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12
Q

what is creatinine concentration used for

A

determine sufficiency of kidney function

determine severity of kidney damage

monitor progression of kidney disease

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13
Q

what is creatinine clearance

A

it is a value which indicates the volume of creatinine in ml removed by the kidneys over a period of time per minute

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14
Q

how do we take creatinine clearance

A

blood is taken from the patient

this is measuring the amount of creatinine in the blood plasma

the higher the level of creatinine in the blood the slower the kidneys are working

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15
Q

which equation do we use to calculate the creatinine clearance

A

there are many but the most common is the cockcroft and gault equation

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16
Q

what is the cockcroft and gault equation

A

it states firstly that factor known as F which is a constant

male = 1.23
female = 1.04

F x (140-age) x weight / serum clearnace

units = ml/min

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17
Q

what is eGFR

A

estimated glomerular filtration rate

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18
Q

how is egfr different from gfr

A

the labs calculate egfr using a different equation and its units are

ml/min/1.73m^2

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19
Q

what is eGFR used for

A

can be used to guide dosage for most drugs in patients of an average build

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20
Q

in what patients must creatitine clearance be measured

Study These Flashcards
A

DOACs

Nephrotoxic

> 75 years

Extreme of muscle mass

Drugs that are renally excreted

Narrow therapeutic index drugs

21
Q

what does DOACs stand for

Study These Flashcards
A

direct-acting oral anticoagulants

22
Q

what can serum creatinine be affected by

Study These Flashcards
A

The amount of muscle tissue you have

High protein in diet

Exercise particularly in muscle building

Any injuries involving damage to the muscle

Malnutrition leading to dramatic weight loss

23
Q

What does AKI stand for

Study These Flashcards
A

Acute Kidney Injury

24
Q

what does AKI replace

Study These Flashcards
A

acute renal failure

25
define acute
develops over hours or days
26
how common are AKI's
1 in 5 patients in A&E | 13-18% of all hospital admission
27
where is AKI common in
patients who are at risk or who are acutely ill or who have had a major surgery
28
What are the risk factors for AKI
``` Age > 75 Previous AKI PRe existing CKD (eGFR <60ml/kg/1.73m^2) Heart failure Atherosclerotic peripheral vascular disease (PVD) Deabetes mellitus Liver Disease Debility and Dementia ```
29
What are triggers for AKI
``` Sepsis or Infection Hypotension Hypovolaemia (dehydration, bleeding) Nephrotoxic medications e.g. gentamicin, NSAIDS, iodinated contrast Anti-Hypertensives ```
30
What are the 3 classifications of AKI
Pre renal Renal Post Renal
31
what is a pre renal aki
inadequate perfusion, not enough blood at sufficient pressure to allow filtering
32
what is a renal aki
cellular damage, damage to the cells that make filtering mechanism possible
33
what is a post renal aki
obstruction, urine unable to drain adequately system backed up
34
what are the main causes of a pre renal aki
intravascular volume depletion - haemorrahge - vomiting - diarrhoea decreased arterial pressure - heart failure - sepsis nephrotoxic medication - ACEIs - ARBs - NSAIDs
35
what are the main causes of post renal aki
kidney stones benign prostatic hyperplasia CNS disorders that may affect outflow such as stroke
36
how do we manage a pre renal AKI
hydration with IV fluids
37
how do we manage a post renal AKI
refer patient to a urologist
38
how do we manage an intrinsic AKI
treat the damage if possible
39
what is a general rule of thumb for AKI management
hold all nephrotoxic medications | adjust doses of all other medications that are prescribed
40
what can further complications include
Hyperkalaemia Metabolic acidosis Fluid overload Uraemic encephalopathy (high levels urea in the blood)
41
How do we manage hyperkaelemia in people who have an AKI
restrict dietary potassium treat insulin or salbutamol causing a shift of potassium from the blood stream into cells Potassium persistently high, patietns may need to undergo urgent dialysis
42
How do we manage acidosis
solution to neutralize the pH of the blood often IV sodium bicarbonate is given and often these patients are admitted to HDU / ITU
43
how do we manage oedema in people who have an AKI
give a loop diuretic e.g. furosemide whic his often given IV at a high dose monitor serum creatine as there is a risk of worsening pre renal aki through dehydration not all patients will be responsive so if persistently fluid overloaded patient may need to go through dialysis
44
how do we manage uraemic encephalopathy
undergo urgent renal replacement therapy (dialysis to remove the toxic urea from the blood
45
what complications require dialysis
hyperkalaemia oedema uraemic encephalopathy
46
what does nephrotoxic mean
Nephrotoxicity is one of the most common kidney problems and occurs when your body is exposed to a drug or toxin that causes damage to your kidneys. When kidney damage occurs, you are unable to rid your body of excess urine, and wastes.
47
give some examples of nephrotoxic potential medicines
``` ACEIs ARBs NSAIDs Diuretics Aminogylcosides Iodinated contrast agents ```
48
what is chronic kidney disease
abnormalities of kidney function or structure present for more than 3 months with implications for health
49
what prompts can lead to taking the GFR
persistant microalbuminuria persistent proteinuria pesrsistant haematuria

Therapeutics (50 decks)

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