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Nephrology > Acute and Chronic Kidney Disease > Flashcards

Acute and Chronic Kidney Disease Flashcards

1
Q

What is the definition of AKI?

A

Sudden decline in renal function resulting in oliguira and uraemia

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2
Q

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

A

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

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3
Q

What are hypotensive causes of pre-renal AKI?

A

Cardiogenic shock
Sepsis
Anaphylaxis

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4
Q

What are cardiovascular causes of pre-renal AKI?

A

Valvular disease,HF and arrhythmia

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5
Q

What could cause volume depletion resulting in AKI?

A

Burns
Haemorrhage
Severe vomiting and diarrhoea
Inappropriate diuresis

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6
Q

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

A

AAA
NSAIDS
ACE
Renal artery stenosis

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7
Q

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

A

Acute tubular necrosis

Ischaemic ATN or Nephrotoxic ATN

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8
Q

What toxins can result in nephrotoxic ATN?

A

Aminoglycosides
Myoglobin
Radiocontrast

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9
Q

What can result in ischaemic ATN?

A

Burns
Dehydration
Renal thrombosis
Haemorrhage

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10
Q

What are vascular causes of intra-renal AKI?

A

Renal vein thrombosis

Renal artery stenosis

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11
Q

What are post renal causes of AKI?

A

Anything causing obstruction

BPH, Calculi or prostate cancer

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12
Q

What are symptoms of pre-renal AKI?

A 
Hypotension 
Syncope 
Orthostatic hypotension 
Tachycardia 
reduced JVP
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13
Q

What are generic symptoms of AKI?

A

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

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14
Q

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

A

Hypertension
Oedmea
Orthopnoea
Raised JVP

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15
Q

What is diagnostic criteria for AKI?

A

<0.5ml/kg urine per hour OR

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

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16
Q

What is management in patient has hyperkalaemia?

A

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

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17
Q

What are indications for dialysis (POPAC) ?

A 
Pulmonary Oedema 
Oedema 
Potassium 
Acidosis 
Complications of uraemia
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18
Q

What drugs should be stopped as they can worsen AKI?

A

ACE and ARBS
NSAIDS
Amino-glycosides
Diuretics

19
Q

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

A

Metformin
Lithium
Digoxin

20
Q

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

A

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

21
Q

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

A

Triad of: Rash, eosinophilia and fever

Usually caused by Beta Lactams and NSAIDS

22
Q

What is the management of Acute Interstitial Nephritis?

A

Withdraw causative medication and start steroid treatment

23
Q

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

A

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

24
Q

What is the definition of rhabdomyolysis?

A

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

25
Q

What is the pathophysiology of rhabdomyolysis?

A

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

26
Q

What are causes of myoglobinuria?

A 
Alcoholism 
Trauma and falls with long lying 
Status epilepticus 
DKA 
Infection 
Heat stroke
27
Q

How does rhabdomyolysis present?

A

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

28
Q

What are electrolyte abnormalities associated with rhabdomyolysis?

A

Hyper K+

Hypo Ca2+

29
Q

What are investigation findings for rhabdomyolysis?

A

Urine - blood positive
CK - 5x baseline
Electrolyte imbalances

30
Q

What are complications of rhabdomyolysis?

A

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

31
Q

What is the most important Mx in rhabdomyolysis?

A

Aggressive fluid rehydration

Mx of high K+

32
Q

What is the definition of CKD?

A

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

33
Q

What is classification of CKD?

A 
Stage one - >90 
Stage 2 - 60-89
Stage 3 - 30 - 59 
Stage 4 - 15-29
Stage 5 - <15
34
Q

What are the most common causes of CKD?

A

DM
HTN
Old age

35
Q

What are other less common causes of CKD?

A

PCKD
IgA nephropathy
Wegners
Sickel Cell

36
Q

What is the renal decline associate with old age?

A

GFR reduced 1ml/min per year after 50 years

37
Q

What are signs of CKD?

A 
Polyuria 
Anorexia 
Pruritus 
Tetany 
Haematuria 
Anaemia 
Oedema 
Fatigue
38
Q

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

A

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

39
Q

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

A

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

40
Q

What is the management of CKD?

A

HTN control - ACE 1st line

Statins

41
Q

What is the management of acidosis in CKD?

A

Oral bicarbonate

42
Q

What is the blood pressure aim for patients with CKD?

A

<130/80 with ACR >70mg/mmol

43
Q

When do you consider renal dialysis?

A

Stage 5 kidney disease

Nephrology (3 decks)

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