Acute and Chronic Kidney Disease

Question 1

What is the definition of AKI?

Answer 1

Sudden decline in renal function resulting in oliguira and uraemia

Question 2

What are the three broad causes of AKI and which is most common?

Answer 2

Pre-renal - most common 90% of cases
Intra-renal
Post- renal

Question 3

What are hypotensive causes of pre-renal AKI?

Answer 3

Cardiogenic shock
Sepsis
Anaphylaxis

Question 4

What are cardiovascular causes of pre-renal AKI?

Answer 4

Valvular disease,HF and arrhythmia

Question 5

What could cause volume depletion resulting in AKI?

Answer 5

Burns
Haemorrhage
Severe vomiting and diarrhoea
Inappropriate diuresis

Question 6

What could result in hypoperfusion of the kidney and therefore AKI?

Answer 6

AAA
NSAIDS
ACE
Renal artery stenosis

Question 7

Of the intrarenal causes of AKI which is the most common and what are the subtypes of this?

Answer 7

Acute tubular necrosis

Ischaemic ATN or Nephrotoxic ATN

Question 8

What toxins can result in nephrotoxic ATN?

Answer 8

Aminoglycosides
Myoglobin
Radiocontrast

Question 9

What can result in ischaemic ATN?

Answer 9

Burns
Dehydration
Renal thrombosis
Haemorrhage

Question 10

What are vascular causes of intra-renal AKI?

Answer 10

Renal vein thrombosis

Renal artery stenosis

Question 11

What are post renal causes of AKI?

Answer 11

Anything causing obstruction

BPH, Calculi or prostate cancer

Question 12

What are symptoms of pre-renal AKI?

Answer 12

Hypotension 
Syncope 
Orthostatic hypotension 
Tachycardia 
reduced JVP

Question 13

What are generic symptoms of AKI?

Answer 13

Oliguria
2nd to uraemia: Abdominal pain , Anorexia; Confusion
Dehydration
Arrhythmia due to electrolyte change

Question 14

What are symptoms of post-renal and intra-renal AKI?

Answer 14

Hypertension
Oedmea
Orthopnoea
Raised JVP

Question 15

What is diagnostic criteria for AKI?

Answer 15

<0.5ml/kg urine per hour OR

>1.5 -1.9 x rise in creatinine from baseline in 48 hours

Question 16

What is management in patient has hyperkalaemia?

Answer 16

Calcium gluconate to stabilise the cardiac membrane
Insulin and salbutamol to move k+ intracellularly
Calcium resonium

Question 17

What are indications for dialysis (POPAC) ?

Answer 17

Pulmonary Oedema 
Oedema 
Potassium 
Acidosis 
Complications of uraemia

Question 18

What drugs should be stopped as they can worsen AKI?

Answer 18

ACE and ARBS
NSAIDS
Amino-glycosides
Diuretics

Question 19

Which drugs should be stopped in the case of AKI as there is increased risk of toxicity?

Answer 19

Metformin
Lithium
Digoxin

Question 20

What investigation can be used to distinguish between pre-renal and intra-renal cause of AKI?

Answer 20

Frational excretion of sodium
>2% suggests intra-renal likely ATN
<1% pre-rental

Question 21

What is the triad of Acute interstitial nephritis and what are the most common implicated causes?

Answer 21

Triad of: Rash, eosinophilia and fever

Usually caused by Beta Lactams and NSAIDS

Question 22

What is the management of Acute Interstitial Nephritis?

Answer 22

Withdraw causative medication and start steroid treatment

Question 23

What is the prognosis of a patient with AKI secondary to ATN?

Answer 23

Good recovery. Tubular cells have high metabolic activity and high cell replacement.

Question 24

What is the definition of rhabdomyolysis?

Answer 24

Clinical syndrome resulting from skeletal muscle breakdown and release of cellular contents.

Question 25

What is the pathophysiology of rhabdomyolysis?

Answer 25

Damage to myocyte membrane causing increase in intracellular Ca2+ resulting in muscle cell necrosis and release of intracellular contents. This is results in propagation of further muscle cell breakdown

Question 26

What are causes of myoglobinuria?

Answer 26

``` Alcoholism Trauma and falls with long lying Status epilepticus DKA Infection Heat stroke ```

Question 27

How does rhabdomyolysis present?

Answer 27

Tea coloured urine Non specific symptoms - N&V fever Evidence of cause of rhabdomyolysis e.g. pain and muscle swelling

Question 28

What are electrolyte abnormalities associated with rhabdomyolysis?

Answer 28

Hyper K+ | Hypo Ca2+

Question 29

What are investigation findings for rhabdomyolysis?

Answer 29

Urine - blood positive CK - 5x baseline Electrolyte imbalances

Question 30

What are complications of rhabdomyolysis?

Answer 30

Cardiac - asystole, HB and VT due to electrolytes AKI due to myoglobin toxicity and precipitation DIC Metabolic acidosis

Question 31

What is the most important Mx in rhabdomyolysis?

Answer 31

Aggressive fluid rehydration | Mx of high K+

Question 32

What is the definition of CKD?

Answer 32

Reduction in renal function to GFR <60 for greater than 3 months duration

Question 33

What is classification of CKD?

Answer 33

``` Stage one - >90 Stage 2 - 60-89 Stage 3 - 30 - 59 Stage 4 - 15-29 Stage 5 - <15 ```

Question 34

What are the most common causes of CKD?

Answer 34

DM HTN Old age

Question 35

What are other less common causes of CKD?

Answer 35

PCKD IgA nephropathy Wegners Sickel Cell

Question 36

What is the renal decline associate with old age?

Answer 36

GFR reduced 1ml/min per year after 50 years

Question 37

What are signs of CKD?

Answer 37

``` Polyuria Anorexia Pruritus Tetany Haematuria Anaemia Oedema Fatigue ```

Question 38

What are indications for a renal USS in diagnosis of CKD ?

Answer 38

Rapid progression of disease Symptoms of obstruction FHX of PCKD Visible or Microscopic haematuria

Question 39

What are other Ix for Dx CKD and what must you tell Pts before measurements?

Answer 39

Creatinine - avoid meat for 12 hrs before Urinalysis U&E GFR calculation

Question 40

What is the management of CKD?

Answer 40

HTN control - ACE 1st line | Statins

Question 41

What is the management of acidosis in CKD?

Answer 41

Oral bicarbonate

Question 42

What is the blood pressure aim for patients with CKD?

Answer 42

<130/80 with ACR >70mg/mmol

Question 43

When do you consider renal dialysis?

Answer 43

Stage 5 kidney disease