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MB2: Renal > AKI and CKD > Flashcards

AKI and CKD Flashcards

1
Q

definition of AKI

A

decreased renal function <48hrs
increase in creat >50%
OR reduction in UO
OR increase in serum creat by >26.4micromol/l

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2
Q

risk factors for AKI

A 
older age 
CKD
diabetes 
cardiac failure 
liver disease
PVD
Previous AKI 
drugs 
hypotension/hypovolaemia 
sepsis
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3
Q

causes of pre renal AKI

A

hypovolaemia
hypotension
sepsis/anaphylaxis
renal hypoperfusion, ACEI/ARB, NSAIDs, hepatorenal syndrome

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4
Q

renal causes AKI

A

vasculitis, renovascular
glomerulonephritis
abx, omeprazole, NSAIDs, sarcoid, TB
ischaemia, gentamicin, contrast, rhabdomyalysis

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5
Q

causes of post renal AKI

A

stones
tumour
stricture
swelling

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6
Q

what is oliguria

A

UO <0.5ml/kg/hr

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7
Q

describe how ACEI/ARB leads to pre renal AKI

A

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

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8
Q

what does untreated pre renal AKI lead to

A

acute tubular necrosis

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9
Q

what may lead to acute tubular necrosis

A

drug toxicity, rhabdomyalysis

sepsis, severe dehydration

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10
Q

management of pre renal AKI

A

monitor UO, HR, BP, JVP, CRT, pulmonary oedema

give 1L crystalloid and seek urgent nephrology help

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11
Q

signs and symptoms of AKI

A 
anorexia 
weight loss 
fatigue 
nausea and vomiting 
itch 
SOB, pitting oedema 
HTN
effusion 
pericarditis 
oliguria
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12
Q

signs more specific to renal AKI

A 
sore throat 
rash 
arthralgia 
D&V
haemoptysis 
recent contrast 
vascular bruit
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13
Q

eosinophilia in the context of AKI is indicative of?

A

interstitial nephritis

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14
Q

raised CK in the context of (renal) AKI is indicative of?

A

rhabdomyalysis

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15
Q

investigations for renal AKI

A

Na,K,Ur,Cr, clotting, Hb, urinalysis
USS
ANA,ANCA,GBM
protein electrophoresis and BJP

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16
Q

treatment of renal AKI

A 
fluid resus and pressors 
treat underlying cause 
abx if septic 
stop ALL nephrotoxics 
dialysis if still anuric and uraemic, they may need it URGENT
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17
Q

life threatening complications of AKI

A

hyperkalaemia
fluid overload
uraemic pericardial effusion

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18
Q

what is regarded as severe uraemia

A

> 40

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19
Q

managing post renal AKI

A

catheterise, nephrostomy

refer to urology

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20
Q

normal serum K

A

3.5-5

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21
Q

serum hyperkalaemia

A

> 5.5

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22
Q

life threatening severe hyperkalaemia

A

> 6.5

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23
Q

ECG features of hyperkalaemia

A 
peaked T wave
flattened P
prolonged PR 
depressed ST
prolonged QRS 
sine wave pattern
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24
Q

management of hyperkalaemia

A 
10ml 10% calcium gluconate 
cardiac monitor 
IV access
insulin, dextrose, salbutamol 
calcium resonate if stable 
bicarb considered
25
Q

urgent indication for haemodialysis

A

hyperkaemia >7 or 6.5 despite tx
acidosis <7.15
fluid overload
urea >40 with pericardial rub/effusion

26
Q

drugs to avoid in AKI

A 
NSAIDs
ACEI/ARB
Diuretics 
contrast 
gentamicin 
trimethoprim
potassium sparing diuretics
27
Q

what is CKD

A

reduction in kidney function/structural damage

>3m with health implication

28
Q

markers of kidney damage?

A 
transplant 
histological abnormalities 
electrolyte abnormalities 
ACR >3
sediment in urine 
structural abnormalities
29
Q

stage 1 CKD

A

> 90ml/min

30
Q

stage 2 CKD

A

60-89ml/min

31
Q

stage 3a CKD

A

45-59ml/min

32
Q

stage 3b CKD

A

30-44ml/min

33
Q

stage 4 CKD

A

15-29ml/min

34
Q

stage 5 CKD

A

<15ml/min

35
Q

class A1 CKD

A

<3

36
Q

class A2 CKD

A

3-30

37
Q

class A3 CKD

A

> 30

38
Q

worst stage of CKD

A

stage 5 class A3

39
Q

what is accelerated progression in CKD

A

persistent decrease in eGFR >25% and change in category within a year

40
Q

cause of CKD

A 
diabetes 
hypertension 
glomerular disease
familial 
nephrotoxic drugs 
obstructive uropathy 
PKD
systemic 
obesity and metabolic syndrome
41
Q

nephrotoxic drugs causing CKD?

A 
ACEI/ARB
diuretics 
aminoglycosides 
bisphosphonates 
calcineurin inhibitors 
lithium
mesalazine 
NSAIDs
42
Q

obstructive uropathies causing CKD?

A 
stricture 
tumour 
calculi 
extrinsic compression from lymph nodes/colon
gynae masses
43
Q

systemic causes of CKD

A

SLE
vasculitis
myeloma

44
Q

familial causes of CKD

A

ADPKD
alport syndrome
familial GN

45
Q

true/false - increase in urine ACR leads to raised risk stroke

A

true

46
Q

what are the uraemic related risk factors on CV health

A 
oxidative stress
inflammation 
endothelial dysfunction 
vascular calcification 
subclinical hypothyroidism
insulin resistance 
atherosclerotic plaques 
volume overload 
uraemic bone disease
47
Q

cause and symptoms of renal anaemia

A

tiredness, SOB, lethargy, palpitations

decreased production of erythropoietin by kidneys

48
Q

pathophysiology of renal mineral and bone disorder

A

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

49
Q

symptoms of renal mineral and bone disorder

A

bone pain, fragility, extra skeletal calcification

50
Q

complications of CKD

A 
renal anaemia 
dyslipidaemia 
hypertension
cardiovascular disease 
renal mineral and bone disorder 
AKI
51
Q

BP target for CKD

A

<140/90

<30/80 if there is CKD and diabetes

52
Q

risk modification treatment for cardiovascular complications?

A 
stop smoking 
weight loss 
aerobic exercise 
low salt diet 
control HTN 
lipid lowering 
consider antiplatelet
53
Q

if starting ACEI, what is considered a normal decline in GFR and rise in creat

A

<25% drop eGFR
<30% rise creat
should stabilise

54
Q

what diet advice should be offered to patients with CKD

A

low phosphate, potassium and sodium diet

55
Q

what can be given for CKD related metabolic acidosis and what is a complication?

A

sodium bicarbonate

can exacerbate fluid retention

56
Q

medications for renal bone mineral disorder

A

active vitamin D
alfacalcidol
phosphate binders

57
Q

who is more at risk of renal anaemia

A

eGFR<45ml/min

diabetics

58
Q

Hb target for renal anaemia

A

100-120g/L

can be lower if on iron replacement and asymptomatic

59
Q

what can be given for renal anaemia

A

oral iron
usually IV iron in later CKD
erythropoietin stimulating agent if really needed

MB2: Renal (11 decks)

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