AKI and CKD module Flashcards
What are the causes of ARF?
Pre-renal
Intrinsic renal
Post-renal
What can cause pre-renal AKI?
Reduced renal perfusion: major haemorrhage, hypovolemia due to severe diarrhoea or vomiting, reduced renal perfusion in sepsis and hypotension due to cardiac causes such as MI
What can pre-renal AKI lead to?
Acute tubular necrosis
What can cause intrinsic renal AKI?
ATN
Acute glomerulonephritis
Acute interstitial nephritis
Rhabdo myloysis
What can cause post-renal AKI?
Obstruction of the urinary tract
2 kidneys must be obstructed to cause ARF so the obstruction must be at the level of the bladder or urethra
What are common complications of ARF?
Hyperkalemia
Metabolic acidosis
Fluid overload
What can an ultrasound of the kidneys show?
Obstruction
Check size of kidneys - CKD will show small, shrunken kidneys
Cysts
What is the treatment of hyperkalemia?
10ml calcium gluconate 10%
10 units actrapid insulin with 50ml 50% dextrose
2.5mg salbutamol neb
What is needed to class someone as having CKD if they fall into stage 1 or 2?
Structural kidney damage: proteinuria or abnormalities on scanning
When will people start to notice symptoms with a low GFR?
When it reaches 20ml/min
How is CKD managed in GP?
Urinalysis: proteinuira for progression of CKD
Haematuria = renal disease or lesion of lower urinary tract
If proteinuria present, send for protein:creatinine ratio - 100mg/mmol is equivalent to Ig per day
What is nephrotic syndrome?
Heavy proteinuria >3g day
Hypoalbuminaemia
Oedema
Hyperlipidaemia
What are the causes of nephrotic syndrome?
Primary glomerulonephritis Minimal change nephropathy Membranous nephropathy Diabetes SLE Malignancy Chronic infections Drugs: gold, penicillamine
How will minimal change and membranous nephropathy present?
Nephrotic syndrome with normal renal function and BP
What tests need to be carried out before a renal biopsy is performed?
Blood count and coag screen - moderate or severe thrombocytopenia and coag defects are CI to biopsy but can be corrected
Renal ultrasound: check that 2 kidneys are present, size and position
What are the contraindications to renal biopsy?
Thrombocytopenia Coag defects Small kidneys - increased bleeding, biopsy inconclusive Uncontrolled hypertension - bleeding Untreated UTI Single kidney
What is the treatment for minimal change nephropathy?
Prednisolone 40-60 mg daily
PPI to protect against peptic ulcer
What are the investigations in nephrotic syndrome?
BP
Urinalysis: if positive for protein
Quantify protein:creatinine ratio
Blood sample to check U&Es and serum albumin
What is the presentation of IgA nephropathy?
Episodes of macroscopic haematuria associated with an URTI
How is IgA nephropathy diagnosed?
Renal biopsy
What drug should be prescribed to control BP in someone with proteinuria?
ACEi: reduced BP and reduces protein excretion, slowing the progression of kidney disease
What is the outcome for IgA nephropathy?
25% will have progressively declining renal function and will require dialysis or transplantation
Heavy proteinuria and scarring are associated with a higher risk of progression
What are the options for renal replacement therapy?
Haemodialysis
Peritoneal dialysis
Pre-emptive transplantation
What does proteinuria with haematuria suggest?
Kidneys are the source of blood
