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Nephrology > Acute/ Chronic kidney Injury > Flashcards

Acute/ Chronic kidney Injury Flashcards

1
Q

What are indications for dialysis ( 6) ?

A
  1. Recurrent pulmonary oedema
  2. Persistent Hyperkalaemia >7 mmol/l
  3. Metabolic acidosis ph <7.2 or BE<10
    (Deutschland: hco3+ <12)
  4. Uraemic complications (e.g. Encephalopathy )
  5. Uraemic pericarditis
  6. Drug Overdose ( Barbiturates, Lithium, alcohol, salicylates , theophylline
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2
Q

How can AKI be classified (3)?

A
  1. Prerenal
  2. Intrinsic
  3. Post renal
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3
Q

What is the most common cause for chronic kidney disease ?

A

1) diabetes

2) glomerulonephritis
3) idiopathic
4) hypertension

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4
Q

How to treat persistent hyperkalaemia ?

Why is it dangerous ?

A
  • Calcium gluconate 10% 10ml (cardioprotective)
  • nebulised salbutamol (drives K into cell)
  • iV insulin and glucose (drives K into cells)
  • if bicarbonate low - iv sodium bicarbonate
  • -> these are only short term measures
  • dialysis if K >7

Hyperkalaemia can cause arrhythmia

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5
Q

Which drugs should be stopped in AKI ?

A 
ACE-I 
(Ang-II Blocker ? )
NSAIDs
Diuretics 
Gentamicin
Nitrofurantoin
Metformin if creatinine > 150 (risk of lactic acidosis )

Antihypertensive if low BP ( but don’t just stop b-blocker , reduce )
Spironolactone if Hyperkalaemia
Caution : opiates can accumulate
Use contrast with caution!!

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6
Q

What are typical uraemic symptoms ?

A 
Anorexia 
Restless legs 
Pruritis
Fatigue/ Weakness 
Amenorrhea in women / impotence in men 
Bone pain 
Nausea + vomiting
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7
Q

How can chronic and acute kidney injury be differentiated ?

A

Ultrasound : chronic –> smaller kidneys
Signs of anaemia in chronic
Ca and Phosphat imbalances

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8
Q

Which kind of anaemia would you expect in a patient with CKD ?

A

Normochromic , normocytic Anaemia

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9
Q

How is end stage renal failure defined ( GFR) ?

A

GFR < 15 ml/min

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10
Q

Which parameter would help to classify the cause of metabolic acidosis ?

A

Anion Gap

If normal: 
GI loss 
Renal tubular acidosis
Acetazolamide
Ammonium Chloride Injection 
Addison's 
Raised: 
Lactate (shock, hypoxia) 
Ketones (diabetes, alcohol) 
Urate ( renal failure) 
Acid poisoning ( salicylates, methanol)
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11
Q

What is the most accurate course of action in a patient with known CKD (GFR 50) who needs a CT with contrast material ?

A

Give IV 0.9% sodium chloride , 1ml/kg/h for 12h pre and post procedure !

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12
Q

Which diseases can present with hypertension and low potassium levels ?

A

Cushing’s
Conn’s
Liddle’s
11 beta hydroxylase deficiency

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13
Q

How is GFR influenced by pregnancy?

A

GFR increases ( often not reflected in eGFR)

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14
Q

Which factors influence the MDRD = ( modification of diet in renal disease )equation to calculate eGFR ?

A

Pregnancy
Muscle mass
Eating red meat 12h prior to testing

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15
Q

A young male has recurrent episodes of haematuria , occurring typically a day or two after having a upper respiratory tract infection. What is the most likely diagnosis ?

A

IgA Nephropathy/ Berger’s Disease

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16
Q

What is a clear contraindication for giving metformin in a patient with CKD ?

A

Creatinine of > 150 mmol/l

17
Q

How should metformin be handled before and after in a patient who is planned to have a contrast CT?

A

Stop on day of procedure , don’t start until 48h later, titrate slowly for 1 week before increasing dose

–> risk of contrast nephropathy

18
Q

A patient presents with fever, rigors and pain in her iliac fossa. She is known to have polycystic kidney disease and had a transplant on her left side 4 months ago.

  1. If the pain was on the left side , what is most likely cause ?
  2. If on right side ?
A
  1. Acute graft rejection: typically signs of infection + occurs less than 6 months after transplant
  2. Infection of a cyst in the diseased kidney
19
Q

What is the normal ph of Urin ?

A

4.5-8

20
Q

What does the presence of acanthocytes in the Urin indicate ?

A

Glomerular disease

-> damage of glomerulus causes damage on RBC’a that pass due to increased stress and turbulence

Nephrology (1 decks)

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