AKI and CKD

Question 1

what is rhabdomyolysis

Answer 1

breakdown of skeletal muscle tissue and the release of the products into the blood

Question 2

name some situations that can trigger rhabdomyolysis

Answer 2

prolonged immobility (particularly in frail patients), extreme exercise, crush injuries or seizures

Question 3

what is the main renal consequence of rhabdomyolysis

Answer 3

myoglobin causes AKI as the products are filtered by the kidney and is toxic in high concentration

Question 4

what are the 4 main products in rhabdomyolysis

Answer 4

myoglobin
potassium
phosphate
creatine kinase

Question 5

clinical sign of rhabdomyolysis

Answer 5

red-brown urine

Question 6

name some symptoms of rhabdomyolysis

Answer 6

muscle aches and pain, oedema, fatigue, confusion

Question 7

main investigations that need to be done in suspected rhabdomyolysis

Answer 7

CK levels
urine
U&E for AKI and hyperkalaemia
ECG to assess heart response

Question 8

management of rhabdomyolysis

Answer 8

IV fluids

Question 9

what is hyperkalaemia

Answer 9

high serum potassium

Question 10

name some medications that may cause hyperkalaemia

Answer 10

spironolactone
ACEi, ARB
NSAIDs
potassium supplements (duh)

Question 11

name some conditions which may cause hyperkalaemia

Answer 11

rhabdomyolysis, tumour lysis syndrome
AKI or CKD
adrenal insufficiency

Question 12

ECG of hyperkalaemia

Answer 12

tall tented T waves

Question 13

acute management of hyperkalaemia

Answer 13

IV calcium gluconate + insulin and dextrose infusion

Question 14

what can be added to management of a patient with hyperkalaemia if they’re acidotic

Answer 14

sodium bicarbonate

Question 15

additional medication that can be added to management of hyperkalaemia

Answer 15

nebulised salbutamol - drives K+ into cells

Question 16

what is chronic kidney disease

Answer 16

abnormal kidney function or structure present for more than 3 months with health implications

Question 17

what is the biggest cause of chronic kidney disease

Answer 17

diabetes

Question 18

name some risk factors for developing chronic kidney disease

Answer 18

family history, increasing age, history of AKI

Question 19

name 2 iatrogenic causes of CKD

Answer 19

radiotherapy, nephrotoxic drugs

Question 20

give 2 examples of nephrotoxic drugs

Answer 20

lithium, NSAIDs

Question 21

name some conditions that can cause and speed up CKD

Answer 21

hypertension, glomerulonephritis, polycystic kidney disease

Question 22

most common presentation of CKD

Answer 22

asymptomatic!!

Question 23

what causes foamy urine

Answer 23

proteinuria

Question 24

name some possible symptoms of CKD

Answer 24

pruritus, loss of appetite, nausea, oedema, muscle cramp, hypertension

Question 25

what is the main investigation used to monitor CKD

Answer 25

eGFR

Question 26

how is proteinuria quantified

Answer 26

urine albumin : creatine ratio

Question 27

how do we identify patients with accelerated progression of CKD

Answer 27

sustained decrease in GFR of 15 OR decrease of eGFR by 25% and a change in CKD category within 12 months

Question 28

blood pressure target for patient with ACR < 70

Answer 28

<140/90

Question 29

blood pressure target for patient with ACR > 70

Answer 29

<130/80

Question 30

what medication should any patient with hypertension and ACR > 30 be prescribed

Answer 30

ACEi

Question 31

what can be added to a patients care who have diabetes and kidney disease

Answer 31

SGLT2i

Question 32

what can we prescribe as lipid lowering therapy in patients with CKD

Answer 32

statin

Question 33

why can CKD cause anaemia

Answer 33

reduced production of erythropoietin by the kidney, reduced RBC survival and iron deficiency

Question 34

when is dialysis indicated for patients with CKD

Answer 34

CKD stage 5

Question 35

what is an acute kidney injury

Answer 35

rapid deterioration of renal function

Question 36

what is the most common category of causes of an AKI

Answer 36

pre-renal

Question 37

pathophysiology of pre-renal causes of AKI

Answer 37

reduced perfusion of the kidneys (+/- hypotension) leading to decreased GFR

Question 38

pathophysiology of intra-renal causes of AKI

Answer 38

consequence of structural damage to the kidney

Question 39

pathophysiology of post-renal causes of AKI

Answer 39

acute obstruction of urine flow within the renal tract causing an increased intratubular pressure and decreased GFR

Question 40

name the 3 main causes of pre-renal AKI

Answer 40

hypovolaemia conditions that cause reduced CO drugs reducing BP

Question 41

what is a complication of untreated pre-renal AKI

Answer 41

acute tubular necrosis

Question 42

2 main criteria used to identify patients with AKI

Answer 42

rise in serum creatine and fall in urine output

Question 43

name 4 indications for urgent haemodialysis

Answer 43

hyperkalaemia unresponsive to medical therapy severe acidosis fluid overload urea>40