AKI and CKD Flashcards
what is rhabdomyolysis
breakdown of skeletal muscle tissue and the release of the products into the blood
name some situations that can trigger rhabdomyolysis
prolonged immobility (particularly in frail patients), extreme exercise, crush injuries or seizures
what is the main renal consequence of rhabdomyolysis
myoglobin causes AKI as the products are filtered by the kidney and is toxic in high concentration
what are the 4 main products in rhabdomyolysis
myoglobin
potassium
phosphate
creatine kinase
clinical sign of rhabdomyolysis
red-brown urine
name some symptoms of rhabdomyolysis
muscle aches and pain, oedema, fatigue, confusion
main investigations that need to be done in suspected rhabdomyolysis
CK levels
urine
U&E for AKI and hyperkalaemia
ECG to assess heart response
management of rhabdomyolysis
IV fluids
what is hyperkalaemia
high serum potassium
name some medications that may cause hyperkalaemia
spironolactone
ACEi, ARB
NSAIDs
potassium supplements (duh)
name some conditions which may cause hyperkalaemia
rhabdomyolysis, tumour lysis syndrome
AKI or CKD
adrenal insufficiency
ECG of hyperkalaemia
tall tented T waves
acute management of hyperkalaemia
IV calcium gluconate + insulin and dextrose infusion
what can be added to management of a patient with hyperkalaemia if they’re acidotic
sodium bicarbonate
additional medication that can be added to management of hyperkalaemia
nebulised salbutamol - drives K+ into cells
what is chronic kidney disease
abnormal kidney function or structure present for more than 3 months with health implications
what is the biggest cause of chronic kidney disease
diabetes
name some risk factors for developing chronic kidney disease
family history, increasing age, history of AKI
name 2 iatrogenic causes of CKD
radiotherapy, nephrotoxic drugs
give 2 examples of nephrotoxic drugs
lithium, NSAIDs
name some conditions that can cause and speed up CKD
hypertension, glomerulonephritis, polycystic kidney disease
most common presentation of CKD
asymptomatic!!
what causes foamy urine
proteinuria
name some possible symptoms of CKD
pruritus, loss of appetite, nausea, oedema, muscle cramp, hypertension
what is the main investigation used to monitor CKD
eGFR
how is proteinuria quantified
urine albumin : creatine ratio
how do we identify patients with accelerated progression of CKD
sustained decrease in GFR of 15 OR decrease of eGFR by 25% and a change in CKD category within 12 months
blood pressure target for patient with ACR < 70
<140/90
blood pressure target for patient with ACR > 70
<130/80
what medication should any patient with hypertension and ACR > 30 be prescribed
ACEi
what can be added to a patients care who have diabetes and kidney disease
SGLT2i
what can we prescribe as lipid lowering therapy in patients with CKD
statin
why can CKD cause anaemia
reduced production of erythropoietin by the kidney, reduced RBC survival and iron deficiency
when is dialysis indicated for patients with CKD
CKD stage 5
what is an acute kidney injury
rapid deterioration of renal function
what is the most common category of causes of an AKI
pre-renal
pathophysiology of pre-renal causes of AKI
reduced perfusion of the kidneys (+/- hypotension) leading to decreased GFR
pathophysiology of intra-renal causes of AKI
consequence of structural damage to the kidney
pathophysiology of post-renal causes of AKI
acute obstruction of urine flow within the renal tract causing an increased intratubular pressure and decreased GFR
name the 3 main causes of pre-renal AKI
hypovolaemia
conditions that cause reduced CO
drugs reducing BP
what is a complication of untreated pre-renal AKI
acute tubular necrosis
2 main criteria used to identify patients with AKI
rise in serum creatine and fall in urine output
name 4 indications for urgent haemodialysis
hyperkalaemia unresponsive to medical therapy
severe acidosis
fluid overload
urea>40
