AKI and CKD

Question 1

Define AKI

Answer 1

A significant deterioration in renal function, which is potentially reversible, over a period of hours or days

Question 2

Name the three different causes of AKI

Answer 2

1) Pre-renal failure
2) Intrinsic renal failure
3) Post-renal failure

Question 3

What are the causes of pre-renal failure AKI?

Answer 3

Renal hypoperfusion

Can be systemic eg. hypovolaemia (bleeding, dehydration) or sepsis

Can be local eg. renal artery stenosis or drugs (ACE inhibitors, NSAIDs)

Question 4

What are the causes of intrinsic renal failure?

Answer 4

Primary renal disease
- Glomerulonephritis

Secondary renal disease
- Diabetes, SLE, myeloma, etc.

Interstitial nephritis
- Usually caused by drugs

Secondary ATN (Acute tubular necrosis – temporary)
- Established after pre-renal failure

Question 5

What causes post-renal failure?

Answer 5

Obstruction/blockage of drainage from kidneys.

Is it a stone in the lumen? Or a tumour in the wall or from somewhere else compressing?

Blockage after the bladder is urinary retention – need a catheter. Can diagnose with abdominal exam – palpate bladder.
Blockage before bladder is hydronephrosis – there is a back pressure, swelling of ureters and kidneys. Can only diagnose with ultrasound.

Question 6

What are the tests for renal dysfunction?

Answer 6

Blood tests, urine tests, radiological tests

Question 7

How is AKI different from CKD?

Answer 7

AKI lasts for hours/days and is reversible

CKD lasts for months/years and is irreversible

Question 8

What are some complications of CKD?

Answer 8

Cardiovascular disease, hypertension, anaemia, bone-mineral metabolism, poor nutritional and functional status, progression of CKD, AKI

Question 9

How do you measure CKD?

Answer 9

Tests for renal excretory function eg. creatinine, cystatin C, eGFR

Tests for albuminuria (proteinuria)

Tests for complications

Diagnostic blood tests

Radiological tests

Question 10

What risk factors are associated with CKD progression?

Answer 10

Hypertension
Diabetes mellitus
Albuminuria
Cardiovascular disease
Smoking
Ethnicity
NSAIDs

Question 11

What is Established Renal Failure?

Answer 11

Also known as ESRF, ESRD, ESKD

The stage of CKD where renal replacement therapy (RRT) is required to safely sustain life

Question 12

Give four examples of renal replacement therapy

Answer 12

1) Haemodialysis (hospital, satellite, home)
2) Peritoneal Dialysis (CAPD, APD)

3) Transplantation
	Deceased-donor transplant
	Living-donor transplant (including pre-emptive)
	Other options (e.g. kidney-pancreas, paired-exchange, desensitisation)

4) Conservative care