Acute kidney disease Flashcards
how do you use serum creatinine to stage for AKI
1.5-.1.9 times normal is stage one
2-3 times normal is stage 2
3 times normal is stage 3
what is the AKI bundle
SALFORD
Sepsis ACE/ARB/nsaids- review labs and leaflets fluid blalance obstruction refferal dipstick
what can hyperkalaemia be mistaken for on an ECG
LBBB
what does hyperkalaemia look like on an ECG
wide QRS
no discernable P waves
regular rhythm
peaked T waves
how do you treat hyperkalaemia
intravenous calcium gluconate
insulin dextrose infusion
what can cause AKI
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
what investigations would you do for someone with AKI
CXR- look for pulmonary oedema or pneumonia dipstick culture renal tract USS stool culture
what does high proteinuria indicate
intrinsic renal disease
what are the indications for dialysis
uncontrolled: hyperkalaemia pulmonary oedema metabolic acidosis uraemic encephalopathy uraemic pericarditis
how do you calculate GFR
1/ creatinine
why are the kidneys susceptible to low blood flow
sluggish blood flow in the counter current multiplier
what are the stages of acute tubular necrosis
oligouric phase
maintenance phase
polyuric phase
what electrolyte disturbance can omeprazole causes
hyponatraemia
what investigations should you do for someone with possible sepsis
blood gas glucose and lactate blood culture full blood count C reactive protein us and es clotting screen
why is lactate measured in sepsis
marker of poor tissue perfusion (shock)
why are us and es measured in sepsis
kidneys are affected early
why is clotting measured in sepsis
in severe sepsis there is dysregulation of coagulation system
What does CAPE stand for
chaperone
analgesia
position patient
exposure
what ABGs might you see in AKI
partially compensated metabolic acidosis
low pH
low bicarb
low CO2
what are the types of AKI
pre renal- anything that reduces renal perfusion
renal- often drugs, vasculitis, nephritis, rhabdomyolysis
post renal- obstruction
cancer stone, prostate
what are the risks for AKI
age CKD obstruction chronic disease: diabetes, heart failure disability sepsis hypovolaemia oligouria nephrotoxic drugs
why are the kidneys particularly susceptible to ischaemic damage
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
what is ATN
usually a combination of ischaemia and toxicity
usually sloughing of renal tubular epithelium
50% associated mortality
few people develop chronic kidney disease
what are the phases of ATM
oligouric phase
maintenance phase
polyuric recovery phase
