acute on chronic kidney disease

Question 1

description

Answer 1

any sudden decline in kidney function in a patient with known CKD

Question 2

common causes

Answer 2

systemic infection
drugs - diuretics, ACE-i, aminoglycosides eg gentamicin
dehydration
urinary tract obstruction or urinary retention

Question 3

less common causes

Answer 3

renal hypoperfusion secondary to dehydration from diarrhoea, diuretics or surgery, cardiac failure, pericardial tamponade, aortic dissection, renal vascular disease
metabolic and toxic causes eg DKA
hypercalcaemia
hyperuricaemia
progression of underlying diseases eg relapse of glomerulonephritis
development of accelerated-phase HTN
pregnancy: at the end or after delivery, pre-eclampsia, eclampsia

Question 4

underlying causes of urinary retention

Answer 4

papillary necrosis and sloughing
stones
pelvic malignancy
bladder cancer
polycystic cysts
clot in the ureter
contrast media, especially in diabetes

Question 5

presentation

Answer 5

the cause of the exacerbation eg infection
features of CKD
features of AKI

Question 6

DDx

Answer 6

raised urea can also be caused by:
intravascular volume depletion
congestive heart failure
GI bleed
corticosteroids
tetracyclines

creatinine levels can be increased by:
muscle damage
decreased tubular secretion eg cimetidine, trimethoprim

ingestion of cooked meat and severe exercise can cause a rapid but temporary rise in serum creatinine

Question 7

prevention

Answer 7

regular monitoring

stay away from NSAIDs, phosphorous based enemas and iodinated contrast media in decreased eGFR