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Gastrointestinal Block > Acute renal failure (AKI and CKD) > Flashcards

Acute renal failure (AKI and CKD) Flashcards

1
Q

Define AKI

A

A rapid (within 7 days) and sustained (>24 hours) reduction in renal failure resulting in oliguria and a rise in serum urea and creatinine

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2
Q

NICE criteria for AKI

A
  1. Rise in creatinine of ≥ 25 micromol/L in 48 hours
  2. Rise in creatinine of ≥ 50% in 7 days
  3. Urine output of < 0.5ml/kg/hour for > 6 hours
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3
Q

List 4 risk factors for AKI

A
  1. CKD
  2. Heart failure
  3. Diabetes
  4. Liver disease
  5. Age > 65 years
  6. Nephrotoxic medications
  7. contrast medium during CT scans.
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4
Q

List the 3 types of AKI and which is the most common

A
  1. Pre-renal (55%)
  2. Intrinsic/ renal (35%)
  3. Post- renal (20%)
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5
Q

List 3 causes of pre-renal AKI

A
  1. Shock (hypovolaemic, cardiogenic, distributive)
  2. Renal artery stenosis
  3. Hypovolaemia (diarrhoea/vomiting or dehydration)
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6
Q

List 4 causes of intrinsic renal AKI

A
  1. Acute glomerulonephritis
  2. ATN
  3. Acute interstitial nephritis
  4. Rhabdomyolysis
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7
Q

List 4 causes of post-renal AKI

A
  1. Kidney stones
  2. pelvic or abdominal masses
  3. ureteral strictures or compression
  4. BPH or prostate cancer
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8
Q

How does AKI present?

A

May be asymptomatic or as renal failure progresses:

  1. reduced urine output
  2. pulmonary and peripheral oedema
  3. arrhythmias (changes in K+ and acid-base balance)
  4. features of uraemia (eg. pericarditis or encephalopathy)
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9
Q

Investigations for AKI?

A
  1. U&Es
  2. Urinalysis
  3. Renal ultrasound
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10
Q

Management of AKI?

A
  1. ABCDE
  2. Identify and treat underlying cause
  3. IV fluids in pre-renal AKI
  4. Stop nephrotoxic and renally excreted drugs
  5. Relieve obstruction in a post-renal AKI
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11
Q

List 4 examples of nephrotoxic medications

A
  1. NSAIDs
  2. ACEi
  3. ARBs
  4. Aminoglycosides eg. gentamicin
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12
Q

List 2 examples of renal excreted drugs

A
  1. Metformin
  2. Lithium
  3. Digoxin
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13
Q

List 3 treatments for hyperkalaemia?

A
  1. IV calcium gluconate
  2. Insulin/dextrose infusion and/or nebulised salbutamol
  3. Dialysis.
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14
Q

List 4 complications of AKI

A
  1. Hyperkalaemia
  2. Fluid overload, heart failure and pulmonary oedema
  3. Metabolic acidosis
  4. Uraemia can lead to encephalopathy or pericarditis
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15
Q

Indications for renal replacement (dialysis) in the acute setting?

A
  • Acidosis
  • Electrolytess - hyperkalaemia
  • Intoxication (poisoning)
  • Oedema - refractory pulmonary oedema
  • Uraemia - encephalopathy or pericarditis
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16
Q

Why may serum creatinine may not be useful in determining eGFR?

What is used instead?

A

Due to differences in muscle

17
Q

What is CKD?

A

Gradual, irreversible decline in kidney function for more than 3 months?

Requires either a decreased GFR (<60) or markers of kidney damage (albuminuria, electrolyte abnormalities etc..)

18
Q

List 4 causes of CKD

A
  1. Diabetes
  2. Hypertension
  3. Age
  4. Glomerulonephritis
  5. Polycystic kidney disease
  6. Medications such as NSAIDS, proton pump inhibitors and lithium
19
Q

List 4 risk factors for CKD

A
  1. Older age
  2. Hypertension
  3. Diabetes
  4. Smoking
  5. Medications that affect the kidneys
20
Q

How does CKD present?

A

Usually asymptomatic (diagnosed on routine testing) but features may incl

  1. Pruritus (itching)
  2. Loss of appetite
  3. Nausea
  4. Oedema
  5. Muscle cramps
  6. Peripheral neuropathy
  7. Pallor
  8. Hypertension
21
Q

Investigations for CKD?

A
  1. eGFR: using U&E blood test
  2. Proteinuria and Haematuria
  3. Albumin:creatinine ratio (ACR) -≥ 3
  4. Renal ultrasound
22
Q

How is CKD staged?

A

G score based on the eGFR:

  • G1 = >90
  • G2 = 60-89
  • G3a = 45-59
  • G3b = 30-44
  • G4 = 15-29
  • G5 = <15 (“end-stage renal failure”)

A score based on the ACR

  • A1 = < 3
  • A2 = 3 – 30
  • A3 = > 30
23
Q

When does NICE recommend CKD should be referred to a specialist?

A
  1. eGFR < 30
  2. ACR ≥ 70 mg/mmol
  3. Accelerated progression
  4. Uncontrolled hypertension despite ≥ 4 antihypertensives
24
Q

Aims of CKD management?

A

Slow the progression

Reduce risk of CVD

Reduce the risk of complications

Treating complications

25
Q

What medication is offered for primary prevention of CVD?

A

Atorvastatin 20mg

26
Q

List 4 complications of CKD

A
  1. Anaemia (↓EPO)
  2. Renal bone disease (CKD-MBD)
  3. CVD
  4. Peripheral neuropathy
  5. Hypertension
  6. Dialysis related problems
27
Q

List 4 features of Renal bone disease

A
  1. Osteoporosis
  2. Osteomalcia
  3. Osteosclerosis
  4. 2o Hyperparathyroidism
28
Q

Pathophysiology of renal bone disease?

A
  1. Descreased Vit D (no 1-alpha hydroxylation in kidneys)
  2. ↑ phosphate and ↓ calcium
  3. 2o hyperparathyroidism
29
Q

What x-ray changes are associated with renal bone disease

A

Spine xray shows sclerosis of both ends of the vertebra and osteomalacia in the centre

“Rugger Jersey spine” due to hyperparathyroidism

30
Q

How is renal bone disease treated?

A
  1. Vitamin D (alfacalcidol and calcitriol)
  2. Low phosphate diet
  3. Bisphosphonates for osteoporosis
31
Q

Pathophysiology of anaemia in CKD?

A

kidneys produced EPO, which stimulates production of RBCs

CKD leads to less EPO and subsequent anaemia

32
Q

Treatment of anaemia in CKD.

A
  1. Iron
  2. Exogenous EPO
33
Q

Treatment of metabolic acidosis in CKD?

A

Oral sodium bicarbonate

34
Q

Treatment of end stage renal failure?

A
  1. Dialysis
  2. Transplant
35
Q

Treatment of hypertension in CKD?

A

ACE inhibitors: Monitor serum K+ as CKD and ACEi both cause hyperkalaemia

Criteria for ACEi:

  • Diabetes plus ACR > 3mg/mmol
  • Hypertension plus ACR > 30mg/mmol
  • All patients with ACR > 70mg/mmol
36
Q

What BP do we aim for in a patient with CKD?

A

< 140/90

Gastrointestinal Block (26 decks)

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