AKI & CKD

Question 1

What is AKI?

Answer 1

An abrupt decrease or cessation of glomerular filtration rate or kidneys stop working– is reversible if the patient gets correct and prompt treatment

Question 2

What is CKD?

Answer 2

A progressive and irreversible decline in glomerular filtration rate

Question 3

What is Renal Failure

Answer 3

A progressive and irreversible decline in glomerular filtration rate

Question 4

3 types of AKI?

Answer 4

1. Pre-renal caused by low blood flow or BP
2. Renal - directly affecting nephrons
3. Post-renal - mostly due to back pressure due to obstructions

Question 5

Examples of Pre-renal AKI?

Answer 5

Hemorrhage, extensive burns, severe vomiting or diarrhea, cardiac failure or septic shock

Question 6

Examples of Renal causes of AKI?

Answer 6

Ischemia, toxins (heavy metals), acute glomerulonephritis, transplant rejection

Question 7

Examples of Post-renal AKI?

Answer 7

Prostatic hypertrophy, surgical accident, ruptured bladder, uretic obstruction etc

Question 8

Causes of AKI?

Answer 8

1. Complications of surgery, severe burns, trauma
2. Renal ischaemia caused by blood clots, hypovolemia
3. Drugs (antibiotics-gentamycin, streptomycin, NSAID aspirin, ibuprofen
4. Kidney stones

Question 9

Causes of Renal lithiasis?

Answer 9

Diet or low fluid intake or UTIs + genetics

Question 10

How do kidney stones form and made of?

Answer 10

Substances in urine become v. concentrated
Made of minerals + acid salts forms

Question 11

What is Pyelonephritis?

Answer 11

Bacterial infection in the kidney, either from an ascending UTI or via the bloodstream & can progress to septic shock

Question 12

Symptoms of Pyelonephritis?

Answer 12

Fever, pain, nausea – symptoms usually develop in a day or less and cells in urine

Question 13

4 Phases of Acute Kidney Injury?

Answer 13

1. ONSET - lasts hours to days
2. Oliguric - 8 to 14 days
3. Diuretic -
4. Recovery

Question 14

What happens during the 2nd stage of AKI?

Answer 14

1. Decreased urine output (decreased GFR)
2. Buildup of endogenous metabolites
3. Fluid retention → edema → if prolonged hypertension

Question 15

What happens during the 3rd stage of AKI?

Answer 15

Diuretic - as kidneys try heal
1. Filtration is increased but absorption is impaired
2. Blood urea, creatinine, etc remain elevated
3. Electrolytes may be depleted

Question 16

Treatment for AKI?

Answer 16

1. First line of treatment is IF possible, to REMOVE the cause
2. Stop nephrotoxic drugs
3. Provide IV fluid

Question 17

Causes of Chronic Kidney Disease?

Answer 17

• Diabetes
• Hypertension
• Obstructive nephropathy - caused by kidney stones, prostate tumour
• Kidney disease - chronic glomerulonephritis, pyelonephritis, polycystic kidney disease
• Renal artery stenosis

Question 18

Types of Chronic Kidney Disease?

Answer 18

1. PRE-RENAL:
2. RENAL:
3. POST-RENAL:
   NB: Some of these causes also apply to acute kidney injury: if AKI is not treated rapidly and successfully, it may lead to CKD

Question 19

What are examples of pre-renal causes of CKD?

Answer 19

Shock, ischaemia

Question 20

What are examples of renal causes of CKD?

Answer 20

Direct damage to nephrons in the kidney due to infection or nephrotoxic injury

Question 21

What are examples of post-renal causes of CKD?

Answer 21

Increased hydrostatic pressure in Bowmans capsule, slowing filtration due to the obstruction of ureters, or blockage in the ureters

Question 22

Kidney function is very sensitive to_____ & this can lead to?

Answer 22

high BP and inflammation, thickening of arterial walls and renal ischemia

Question 23

GFR maintained at arterial blood pressures of?

Answer 23

80 - 180

Question 24

Stages of CKD?

Answer 24

• DIMINISHED RENAL RESERVE: - no signs and symptoms
• RENAL INSUFFICIENCY:
  Waste products build up
  Inability to concentrate or dilute urine
  75% or more nephrons are lost
• END STAGE:
  Oliguria present waste products build up
  Treatment required
  90% or more nephrons are lost

Question 25

Markers of Kidney Damage?

Answer 25

Persistent albuminuria, WBCs, RBCS and ultra sound abnormalities

Question 26

CKD Risk factors?

Answer 26

* Age 50+ years * Diabetes * High blood pressure * Smoking * Obesity & Family history

Question 27

CKD Common Causes?

Answer 27

Diabetes High BP Rhabdomyolysis (significant muscle damage) Chronic analgesic nephropathy Polycystic kidney disease Kidney stones Kidney infection

Question 28

What is Rhabdomyolysis and what does it cause?

Answer 28

Significant muscle damage and 1. Muscle cell components such as myoglobin released in bloodstream, resulting in electrolyte imbalances 2. Muscle tissue damage leads to high plasma potassium and low plasma calcium

Question 29

What is Chronic Analgesic Nephropathy?

Answer 29

NSAIDs inhibit cyclooxygenases which is required to produce prostaglandins

Question 30

What is the use of Prostaglandin E2?

Answer 30

Produced by the kidney and ensures adequate blood flow to the kidney

Question 31

Decreased blood flow results in damage in the most sensitive areas which are?

Answer 31

The inner medulla (interstitial nephritis) and renal papillae (renal papillary necrosis)

Question 32

What is Polycystic kidney disease (PKD)?

Answer 32

1. A Genetic disease, usually autosomal dominant 2. Multiple (poly) fluid-filled cysts grow out of nephrons; cysts may also be present in the spleen and/or liver 3. Leads to high Bp and eventual kidney failure

Question 33

What happens if enlarged prostrate?

Answer 33

1. Enlarged prostate squeezes the urethra and blocks the flow of urine 2. Initial diagnosis usually from urine not flowing properly – interrupted stream, slowed stream, discomfort