AKI and CKD Flashcards
definition of AKI
decreased renal function <48hrs
increase in creat >50%
OR reduction in UO
OR increase in serum creat by >26.4micromol/l
risk factors for AKI
older age CKD diabetes cardiac failure liver disease PVD Previous AKI drugs hypotension/hypovolaemia sepsis
causes of pre renal AKI
hypovolaemia
hypotension
sepsis/anaphylaxis
renal hypoperfusion, ACEI/ARB, NSAIDs, hepatorenal syndrome
renal causes AKI
vasculitis, renovascular
glomerulonephritis
abx, omeprazole, NSAIDs, sarcoid, TB
ischaemia, gentamicin, contrast, rhabdomyalysis
causes of post renal AKI
stones
tumour
stricture
swelling
what is oliguria
UO <0.5ml/kg/hr
describe how ACEI/ARB leads to pre renal AKI
reduced renal perfusion leads to raised renin, ATII stimulation and efferent arteriole constriction to preserve GFR
this is lost in ACEI so loss of volume results in massive loss of GFR
what does untreated pre renal AKI lead to
acute tubular necrosis
what may lead to acute tubular necrosis
drug toxicity, rhabdomyalysis
sepsis, severe dehydration
management of pre renal AKI
monitor UO, HR, BP, JVP, CRT, pulmonary oedema
give 1L crystalloid and seek urgent nephrology help
signs and symptoms of AKI
anorexia weight loss fatigue nausea and vomiting itch SOB, pitting oedema HTN effusion pericarditis oliguria
signs more specific to renal AKI
sore throat rash arthralgia D&V haemoptysis recent contrast vascular bruit
eosinophilia in the context of AKI is indicative of?
interstitial nephritis
raised CK in the context of (renal) AKI is indicative of?
rhabdomyalysis
investigations for renal AKI
Na,K,Ur,Cr, clotting, Hb, urinalysis
USS
ANA,ANCA,GBM
protein electrophoresis and BJP
treatment of renal AKI
fluid resus and pressors treat underlying cause abx if septic stop ALL nephrotoxics dialysis if still anuric and uraemic, they may need it URGENT
life threatening complications of AKI
hyperkalaemia
fluid overload
uraemic pericardial effusion
what is regarded as severe uraemia
> 40
managing post renal AKI
catheterise, nephrostomy
refer to urology
normal serum K
3.5-5
serum hyperkalaemia
> 5.5
life threatening severe hyperkalaemia
> 6.5
ECG features of hyperkalaemia
peaked T wave flattened P prolonged PR depressed ST prolonged QRS sine wave pattern
management of hyperkalaemia
10ml 10% calcium gluconate cardiac monitor IV access insulin, dextrose, salbutamol calcium resonate if stable bicarb considered
urgent indication for haemodialysis
hyperkaemia >7 or 6.5 despite tx
acidosis <7.15
fluid overload
urea >40 with pericardial rub/effusion
drugs to avoid in AKI
NSAIDs ACEI/ARB Diuretics contrast gentamicin trimethoprim potassium sparing diuretics
what is CKD
reduction in kidney function/structural damage
>3m with health implication
markers of kidney damage?
transplant histological abnormalities electrolyte abnormalities ACR >3 sediment in urine structural abnormalities
stage 1 CKD
> 90ml/min
stage 2 CKD
60-89ml/min
stage 3a CKD
45-59ml/min
stage 3b CKD
30-44ml/min
stage 4 CKD
15-29ml/min
stage 5 CKD
<15ml/min
class A1 CKD
<3
class A2 CKD
3-30
class A3 CKD
> 30
worst stage of CKD
stage 5 class A3
what is accelerated progression in CKD
persistent decrease in eGFR >25% and change in category within a year
cause of CKD
diabetes hypertension glomerular disease familial nephrotoxic drugs obstructive uropathy PKD systemic obesity and metabolic syndrome
nephrotoxic drugs causing CKD?
ACEI/ARB diuretics aminoglycosides bisphosphonates calcineurin inhibitors lithium mesalazine NSAIDs
obstructive uropathies causing CKD?
stricture tumour calculi extrinsic compression from lymph nodes/colon gynae masses
systemic causes of CKD
SLE
vasculitis
myeloma
familial causes of CKD
ADPKD
alport syndrome
familial GN
true/false - increase in urine ACR leads to raised risk stroke
true
what are the uraemic related risk factors on CV health
oxidative stress inflammation endothelial dysfunction vascular calcification subclinical hypothyroidism insulin resistance atherosclerotic plaques volume overload uraemic bone disease
cause and symptoms of renal anaemia
tiredness, SOB, lethargy, palpitations
decreased production of erythropoietin by kidneys
pathophysiology of renal mineral and bone disorder
disturbed vitamin D, calcium, PTH and phosphate due to impaired intestine absorption
abnormalities in bone turnover, mineralisation due to vit D deficiency, raised PO4, low calcium and secondary/tertiary hyperparathyroidism
symptoms of renal mineral and bone disorder
bone pain, fragility, extra skeletal calcification
complications of CKD
renal anaemia dyslipidaemia hypertension cardiovascular disease renal mineral and bone disorder AKI
BP target for CKD
<140/90
<30/80 if there is CKD and diabetes
risk modification treatment for cardiovascular complications?
stop smoking weight loss aerobic exercise low salt diet control HTN lipid lowering consider antiplatelet
if starting ACEI, what is considered a normal decline in GFR and rise in creat
<25% drop eGFR
<30% rise creat
should stabilise
what diet advice should be offered to patients with CKD
low phosphate, potassium and sodium diet
what can be given for CKD related metabolic acidosis and what is a complication?
sodium bicarbonate
can exacerbate fluid retention
medications for renal bone mineral disorder
active vitamin D
alfacalcidol
phosphate binders
who is more at risk of renal anaemia
eGFR<45ml/min
diabetics
Hb target for renal anaemia
100-120g/L
can be lower if on iron replacement and asymptomatic
what can be given for renal anaemia
oral iron
usually IV iron in later CKD
erythropoietin stimulating agent if really needed
