Acute kidney disease

Question 1

how do you use serum creatinine to stage for AKI

Answer 1

1.5-.1.9 times normal is stage one

2-3 times normal is stage 2

3 times normal is stage 3

Question 2

what is the AKI bundle

Answer 2

SALFORD

Sepsis
ACE/ARB/nsaids- review
labs and leaflets
fluid blalance
obstruction 
refferal
dipstick

Question 3

what can hyperkalaemia be mistaken for on an ECG

Answer 3

LBBB

Question 4

what does hyperkalaemia look like on an ECG

Answer 4

wide QRS
no discernable P waves
regular rhythm
peaked T waves

Question 5

how do you treat hyperkalaemia

Answer 5

intravenous calcium gluconate

insulin dextrose infusion

Question 6

what can cause AKI

Answer 6

pre renal -diarrhoea, ACEi, diuretic, dehydration, shock, hepatorenal syndrome, heart failure

intrarenal- NSAIDS, ARBS, ACE, gentamicin, contrast, nephritis, rhabdomylosis

obstruction- stones, prostate, cancer

sepsis

other

Question 7

what investigations would you do for someone with AKI

Answer 7

CXR- look for pulmonary oedema or pneumonia
dipstick
culture
renal tract USS
stool culture

Question 8

what does high proteinuria indicate

Answer 8

intrinsic renal disease

Question 9

what are the indications for dialysis

Answer 9

uncontrolled: 
hyperkalaemia
pulmonary oedema
metabolic acidosis
uraemic encephalopathy
uraemic pericarditis

Question 10

how do you calculate GFR

Answer 10

1/ creatinine

Question 11

why are the kidneys susceptible to low blood flow

Answer 11

sluggish blood flow in the counter current multiplier

Question 12

what are the stages of acute tubular necrosis

Answer 12

oligouric phase
maintenance phase
polyuric phase

Question 13

what electrolyte disturbance can omeprazole causes

Answer 13

hyponatraemia

Question 14

what investigations should you do for someone with possible sepsis

Answer 14

blood gas
glucose and lactate
blood culture
full blood count
C reactive protein
us and es
clotting screen

Question 15

why is lactate measured in sepsis

Answer 15

marker of poor tissue perfusion (shock)

Question 16

why are us and es measured in sepsis

Answer 16

kidneys are affected early

Question 17

why is clotting measured in sepsis

Answer 17

in severe sepsis there is dysregulation of coagulation system

Question 18

What does CAPE stand for

Answer 18

chaperone
analgesia
position patient
exposure

Question 19

what ABGs might you see in AKI

Answer 19

partially compensated metabolic acidosis
low pH
low bicarb
low CO2

Question 20

what are the types of AKI

Answer 20

pre renal- anything that reduces renal perfusion

renal- often drugs, vasculitis, nephritis, rhabdomyolysis

post renal- obstruction
cancer stone, prostate

Question 21

what are the risks for AKI

Answer 21

age
CKD
obstruction 
chronic disease: diabetes, heart failure
disability
sepsis
hypovolaemia
oligouria
nephrotoxic drugs

Question 22

why are the kidneys particularly susceptible to ischaemic damage

Answer 22

low and sluggish blood flow in the counter current multiplier mechanism

the RAAS system tries to protect from this
however, ACE inhibitors, arbs and nsaids can interfere with this mechanism

Question 23

what is ATN

Answer 23

usually a combination of ischaemia and toxicity

usually sloughing of renal tubular epithelium

50% associated mortality

few people develop chronic kidney disease

Question 24

what are the phases of ATM

Answer 24

oligouric phase
maintenance phase
polyuric recovery phase