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Urinary > 6- CKD and AKI > Flashcards

6- CKD and AKI Flashcards

1
Q

What is an AKI

A

Renal function deterioration over hours/days

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2
Q

What rises in AKI (Blood)

A

Urea and creatinine

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3
Q

Is AKi reversible

A

Can be

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4
Q

Consequences of AKI

A

Volume overload, metabolic acidosis, hyperkalemia

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5
Q

What causes the most AKIs

A

Pre renal cause

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6
Q

Pre-renal causes

A

Hypovolemic
Shock
Renal artery stenosis
NSAIDs and ACEI

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7
Q

How do NSAIDs and ACEI cause AKI

A

Impair mechanism of renal autoregulation

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8
Q

Intrinsic causes of AKI

A

Acute tubular necrosis- ischemia, rhabdomyolysis, drug toxicity, toxins

Acute interstitial nephritis- drugs, hypercalcemia, myeloma

Glomerular disease- acute glomerulonephritis, rapidly progressive glomerulonephritis.

Vascular disease- vasculitis, malignant hypertension, thrombotic microangiopathies

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9
Q

What is a sign of Rhabdomyolysis

A

Dark urine. Muscle breakdown–> myoglobin –> filtered but toxic.

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10
Q

Post renal causes of AKI

A

Bladder outflow obstruction
Tumour
Stone- bilateral to cause AKI
Retroperitoneal fibrosis causing ureteral obstruction

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11
Q

Basic investigations

A

Urine test- microscopy, dipstick, cytology
Bloods
Imaging

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12
Q

What biochemical changes occur

A

Increased plasma urea, creatinine, urate, phosphate, potassium
Decreased plasma sodium, calcium
Metabolic acidosis
Increased anion gap

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13
Q

How to manage AKI

A

Fluid replacement to optimise flow and correct hypovolemia
Correct electrolyte imbalances
Catheter if obstruction

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14
Q

What are the life threatening complications of AKI

A

Hyperkalemia
Pulmonary oedema
Bleeding

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15
Q

What is CKD

A

Progressive loss of function over months and years

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16
Q

Is CKD reversible

A

No, renal tissue replaced by extracellular matrix in response to damage.

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17
Q

Whats a good GFR

A

> 90

18
Q

Stage 2

A

60-89

19
Q

Stage 3

A

30-59

20
Q

Stage 4

A

15-29 RRT

21
Q

Stage 5

A

<15 -dialysis or transplant

22
Q

Increased incidences in what people

A

Ethnic, elderly, multi-morbid, social deprivation, diabetes, hypertension

23
Q

Pathology of CKD- what happens to kidney

A

Medulla maintains but cortex (where nephrons are) thin.

24
Q

Who gets CKD screening

A

Diabetes
Hypertension
CVD
Those on nephrotoxic drugs

25
Q

What blood tests to use

A 
U&amp;Es
eGFR
Bone biochemistry
FBC
CRP
Iron 
PTH
26
Q

Other investigations for CKD

A

USS- kidney size
Biopsy
CT
MRI

27
Q

Management

A 
Lifestyle modification 
Uncontrolled diabetes control
Hypertension control
Proteinuria - ACEI
Lipid control
28
Q

What are the functions of the kidneys

A

BP, volume, pH, electrolytes, osmolality, excretion of waste, metabolism of drugs

29
Q

What is the endocrine function of the kidneys

A

Inactive Vit D, renin, EPO

30
Q

Water handling in kidney during CKD

A

Reduced GFR means lost ability to maximally dilute and concentrate urine.

31
Q

Nocturia in CKD

A

Small filtrate but same solute loads causes osmotic diuresis- reduces maximum concentrating ability and response to ADH

32
Q

Effect on low GFR on K+ (and ACEI)

A

Hyperkalaemia

Need to stop ACEI as aldosterone helps to excrete K+ by increasing ROMK expression

33
Q

CKD and bone mineral disease

A

Decreased activation of Vit D = less Ca = PTH stimulated = bone breakdown. As kidneys aren’t functioning well then PO4 isn’t excreted = precipitates = vessels, joints, skin. Manage: give Vit D supplements

34
Q

Drug sensitivity in CKD

A

Increased as elimination is impaired.

35
Q

Accumulation of waste products- symptoms

A

Uraemic symptoms- reduced appetite, nausea and vomiting, pruritus

36
Q

End stage renal failure

A

GFR < 15mls/min

Requires RRT

37
Q

Symptoms of dialysis

A

Tiredness, sleep issues, concentration issues, volume overload, nausea, restless legs, sexual dysfunction, increased infection

38
Q

Hemodialysis times and pills

A

4 hrs x 3 times a week + 19 tablets, EPO and iron

39
Q

Peritoneal dialysis

A

4-5 bags and day or overnight

40
Q

Transplant

A

Reduced morbidity and mortality
QOL
Infection risk
Immunosuppressants- diabetes, hypertension risk

Urinary (11 decks)

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