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Path Y > AKI & CKD > Flashcards

AKI & CKD Flashcards

1
Q

What is a normal GFR?

A

120mls/ min

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2
Q

What is the gold-standard measure of GFR?

A

Inulin clearance

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3
Q

give 3 clinically-viable exogenous markers of GFR?

A

51Cr-EDTA - Edetate Chromium
99Tc-DTPA - diethylene-triamine-pentaacetate)
Iohexol

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4
Q

what equation uses plasma creatinine to estimate GFR?

A

Clearance = (U x V)/P
concentration of creatinine in urine = U
concentration of creatinine in plasma = P
volume of urine collected in T minutes = V

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5
Q

why does plasma urea have a limited clinical value for measuring renal function?

A

variable (30-60%) reabsorption by tubular cells

dependent on nutritional state, hepatic function, GI bleeds

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6
Q

describe the movement of creatinine from blood to urine

A

Freely filtered
Actively transported into urine by tubular cells

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7
Q

what formula estimates clearance using serum creatinine concentration?

A

Cockcroft Gault Equation

(eCCR)

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8
Q

what cells produce cystatin C & how is it correlated w GFR?

A

produced by all nucleated cells
freely filtered at glomerulus
almost completely reabsorbed by tubular cells
inversely correlated w GFR

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9
Q

In what 3 circumstances does cystatin C not give a reliable result for GFR estimation?

A

hyperthyroidism
malignancy
corticosteroids

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10
Q

How can proteinuria be quantified?

A

Spot urine measurement

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11
Q

what can a 24-hour urine collection be used for?

A
  1. Creatinine clearance estimation
  2. Examination for stone-forming elements
  3. Proteinuria quantification (but this can also be done on spot urine testing)
  4. Electrolyte estimation (but this can also be done on spot urine testing)
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12
Q

what is the first choice of imaging in a suspected renal stone?

A

CT KUB
2nd = USS KUB
plain KUB may show stag horn calculi

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13
Q

what is the first choice of imaging to assess renal blood flow?

A

USS with doppler

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14
Q

what is the first choice of imaging in investigating renal structural abnormalities?

A

CT

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15
Q

recall the increases in creatinine that define each stage of AKI

A

Stage 1: 1.5-1.9 x the reference
Stage 2: 2-2.9 x the reference
Stage 3: >=3 x the reference (or >354)

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16
Q

recall 5 differentials for pre-renal AKI

A

true volume depletion e.g haemorrhage in accident
hypotension
oedematous state (heart failure)
renal artery stenosis
drugs

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17
Q

Recall 5 drug classes that can predispose to pre-renal AKI and the mechanism of each of these

A

ACEi & ARBs - decrease efferent constriction
NSAIDs & Calcineurin inhibitors - decrease afferent arteriolar dilatation
Diuretics: decrease pre-load

18
Q

When does AKI become only partially reversible?

A

When acute tubular necrosis occurs

19
Q

recall 5 differentials for the causes of post-renal AKI

A

It’s an obstructive pathology:

  1. kidney stone
  2. bilateral ureteric obstruction (BPH)
  3. cancer of pelvis, colon or cervix
  4. ormond’s disease - Retroperitoneal fibrosis
  5. blocked urinary catheter
20
Q

recall 4 causes of intrinsic renal AKI

A

vascular causes (vasculitis/ vasculitides)
glomerular (glomerulonephritis)
tubular (ATN)
interstitial (analgesic nephropathy)
abnormal protein deposition- myoglobin (rhabdomyolysis), immunoglobin (amyloidosis - nephrotic syndrome, myeloma)
drugs - aminoglycosides (gentamicin etc), amphotericin, aciclovir

21
Q

what is the most common cause of intrinsic renal AKI?

A

Acute tubular necrosis

22
Q

what are the 2 best measures of AKI severity?

A

Creatinine
Urine output

23
Q

how is CKD stage 1 defined?

A

Kidney damage with normal GFR (>90)

24
Q

how is CKD stage 5 defined?

A

End-stage kidney failure - GFR <15 or dialysis

25
Q

What is the best measure of prognosis in CKD?

A

Albumin creatinine ratio

26
Q

What is the most common cause of CKD?

A

Diabetes by a long mile

27
Q

how can CKD cause a failure of homeostatsis as a first consequence?

A

1a- Can cause acidosis due to reduced H+ excretion

1b Can cause hyperkalaemia due to reduced K+ excretion

28
Q

how can CKD cause a failure of hormonal function as a second consequence?

A

2a- Can lead to a normochromic normocytic anaemia due to failure of EPO production

2b- Can cause reduced bone density due to failure of PTH action

Buildup of phosphorus is associated with less calcium in your blood and with the release of PTH by your parathyroid glands. PTH moves calcium out of your bones and into your blood. The loss of calcium can harm your bones.

29
Q

how can end-stage CKD affect the heart as a third & most important consequence?

A

> uraemic cardiomyopathy

30
Q

how should renal bone disease be treated (3 ways)?

A
  1. Phosphate control (phosphate binding drugs) & diet
  2. Vitamin D receptor activators (eg alfacalcidiol, paracalcitol)
  3. PTH suppression (cinacalcet - increases sensitivity of CaSr)
31
Q

how is CKD stage 2 defined?

A

GFR between 60-89

32
Q

how is CKD stage 3 defined?

A

GFR between 30-59

33
Q

how is CKD stage 4 defined?

A

GFR between 15-29

34
Q

give 5 causes of CKD

A

diabetes
hypertension
polycystic kidney disease
chronic glomerulonephritis
infective or obstructive uropathy

35
Q

what’s the fourth & final consequence of CKD

A

uraemia & death

36
Q

how does CKD cause renal bone disease?

A

Renal osteodystrophy has been classically described to be the result of hyperparathyroidism secondary to hyperphosphatemia combined with hypocalcemia, both of which are due to decreased excretion of phosphate by the damaged kidney

Unable to: excrete phosphate from kidneys / make vitamin D

lower vitamin D leads to 2nd HPT

Excess phosphate complexes with Ca2+ causing hypocalcaemia

Phosphate-calcium crystals deposit = renal osteodystrophy

bone diseases linked to CKD = osteitis fibres cystica, osteomalcia

37
Q

what is the treatment of anaemia due to CKD?

A

TREATMENT: use artificial erythropoiesis-stimulating agents (ESAs)
Erythropoietin alfa (Eprex)
Erythropoietin beta (NeoRecormon)
Darbopoietin (Aranesp)

38
Q

what’s the treatment of acidosis due to CKD?

A

oral sodium bicarbonate

39
Q

what dietary measures should be taken by those with CKD?

A

avoid foods rich in potassium = chocolate, tomatoes, milk, dried fruits.

40
Q

outline 3 treatment options in CKD?

A

transplantation
haemodialysis
peritoneal dialysis

41
Q

what’s a contraindication for transplantation?

A

active sepsis
not HIV, high BMI, age or malignancy

42
Q

what are 5 indications for dialysis?

A

Refractory hyperkalaemia
Refractory fluid overload
Metabolic acidosis
Uraemic symptoms (encephalopathy, nausea, pruritis, malaise, pericarditis)
CKD stage 5 (GFR <15mL/min)

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