AKI CKD Flashcards

1
Q

what is AKI

A

a rapid reduction in kidney function leading to an inability to maintain electrolyte acid base and fluid homeostasis

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2
Q

How is AKI defined based on creatinine

A

stage 1 increase by >26, or 1.5-1.9x the reference
stage 2 increase by 2.0 to 2.9 x the reference
stage 3 increase by >3 x the reference

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3
Q

why does pre renal AKI occur

A

poor perfusion - due to failure of normal adaptive mechanisms designed to maintain renal perfusion (baroceptors activated by low BP, activation of ras, release of vasopressin)

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4
Q

which drugs may predispose patients to develop pre-renal AKI

A

NSAIDS - decrease afferent arteriolar dilatation, calcineurin inhibitors - decrease afferent arteriolar dilation, ACEi or ARBs - decrease efferent arteriolar constriction, diuretics - affect tubular function, decrease preload

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5
Q

whats the difference between pre renal AKI and ATN with regards to responding to restoration of circulating volume

A

prerenal responds but AKI does not

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6
Q

name some causes of post renal AKI

A

hallmark is physical obstruction to urine flow, intrarenal, ureteric, prostatic, blocked catheter

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7
Q

what are some causes of intrinsic AKI

A

vascular disease, glomerular, tubular, interstitial disease e.g. analgesic nephropathy

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8
Q

direct tubular injury causes

A

ischaemic, endogenous toxins e.g. myoglobin, immunoglobulins, exogenous toxins e.g. aminoglycosides, amphotericin, acyclovir

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9
Q

why do same cases of AKI not improve

A

imbalance between scarring and remodelling

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10
Q

stages of CKD

A
Normal GFR >90 ml/min
mild 60+
moderate 30+
severe 15+
endstage <15
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11
Q

commonest causes of CKD

A

diabetes, atherosclerotic, hypertension, glomerulonephritis, infective, PCKD

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12
Q

consequences of CKD

A

failure of homeostasis - acidosis, hyperkalaemia, progressive failure of hormonal function - anaemia (epO), renal bone disease, cardiovascular - uraemic cardiomyopathy, vascular calcification

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13
Q

how to treat anaemia of chronic renal disease

A

erythropoeitin stimulating agents like eprex

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14
Q

renal bone disease types

A

osteitis fibrosa (osteoclast resorption of calcified bone and replacement by fibrous tissue) osteomalacia, adynamic bone disease, mixed osteodystrophy

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15
Q

hyperparathyroidism in CKD

A

hypocalcaemia, leads to hyperparathyroidism, resistance to PTH and more hyperparathyroidism

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16
Q

treatment of renal bone disease

A

phosphate control, phostphate binders, vitamin D receptor activators (1 alpha calcidol), direct PTH suppression e.g. cinacalcet

17
Q

stages of uraemic cardiomyopathy

A

LV hypertrophy, lv dilatation, lv dysfunction

18
Q

patient has new onset AKI after severe bruising

A

rhabdomyolysis

19
Q

what two measures do we use to define AKI

A

urine output and creatinine

20
Q

contraindication to renal transplant

A

active sepsis

21
Q

A 68 year old man with previously normal
renal function is found to have a creatinine of
624μmol/l. Renal ultrasound shows dilatation of both kidneys. What is the likely
cause of his AKI?(

A

Benign prostatic hypertrophy