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Yr5 Urology > AKI & CKD > Flashcards

AKI & CKD Flashcards

1
Q

What is the definition of AKI?

A

A clinical syndrome characterised by an abrupt reduction in kidney function in a previous normal kidney

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2
Q

What are the different stages of AKI?

A

STAGE 1: Absolute ↑Creatinine >26 within 48hours OR >50%↑ in Creatinine from baseline in 7d OR 25%↓ in eGFR in 7days OR UO <0.5ml/kg/hr for >6hours
STAGE 2: Creatinine >2-3x baseline OR eGFR >50% or UO <0.5ml/kg/hr for >12hrs
STAGE 3: Cr >354 OR >x3 baseline OR eGFR >70% OR UO < 0.3ml/kg/hr for 24hours OR use of RRT

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3
Q

What signs can show the severity of an AKI?

A
  • Fluid overload: Pulmonary crackles, ↑JVP, peripheral oedema, gallop rhythm
  • Fluid depletion: Postural hypoT (<90/60), tissue turgor, dry mucous membranes, sunken eyes
  • Urine output: Oligo/anuria
  • HyperK
  • Acidosis
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4
Q

What are the signs of hyperK on an ECG?

A 
Tall tented T-waves
Flat P waves
Broad QRS
Sliping ST
Sine wave ECG
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5
Q

How are 80% of cases of AKI resolved?

A

Fluid assessment & replacement
Tx acidosis
Tx sepsis
STOP nephrotoxic drugs

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6
Q

What are the pre-renal causes of AKI?

A 
Hypovolaemia (HF, blood/fluid loss, D&amp;V)
Sepsis
RAS (worse w/ACEi)
Nephrotic syndrome
Nephrotoxic drugs
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7
Q

Which drugs are nephrotoxic?

A

Vasomotor nephropathy: ACEi, ARB, NSAIDs
Allergy: NSAIDs, Abx: Trimethoprim, Vancomycin, ahminoglycosides
Direct nephrotoxicity: Gentamicin, Contrast
Diuretics
↑risk of toxicity: Metformin, Lithium, Digoxin

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8
Q

What are the renal/intrinsic causes of AKI?

A 
GN
Acute tubular necrosis
Acute interstitial nephritis
Thrombotic microangiopathy
Rhabdomyolysis
Tumour lysis
Myeloma
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9
Q

What are the post-renal causes of AKI?

A

Ureteric stones
Ureteric retroperitoneal fibrosis/tumour
BPH
RTA

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10
Q

What are the indication for dialysis?

A 
AEIOU
A: Metabolic acidosis
E: Electrolyte disturbance
I: Intoxication
O: Overload
U: Uraemia (pericarditis, encephalopathy, bleeding)
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11
Q

How is an AKI investigated?

A

Bloods: FBC, U&E, LFT (↑ALP), ESR/CRP, Ca2+, CK, Coag, K+
Urine dip: Protein, blood, leukocytes, nitrates +/- MC&S
ABG: Metabolic acidosis
Immunology screen: ANCA, ANA, anti-GBM, ASO titre, Complements
ECG: HyperK
USS: In 24hrs if obstruction

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12
Q

How is AKI treated?

A

HOLD nephrotoxic drugs

HOLD K+ supplements

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13
Q

How is hyperkalaemia treated?

A

Calcium gluconate: 30ml in 10% bolus IV REPEAT every 20mins until ECG normalises
Insulin: Actrapid 10u in 50ml of 50% Dextrose
Salbutamol: 5mg news x4
Calcium resonium: 15g PO TDS
Haemodialysis

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14
Q

In AKI how is acidosis treated?

A

IV Bicarb: 50-100ml 8.4% in 30mins

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15
Q

How is an obstructive AKI treated?

A

Catheter- monitor UO

USS ASAP

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16
Q

What are the complications of dialysis?

A

HypoK
Intravascular hypoV
Alkalosis
Air embolism

17
Q

What are the SE of dialysis?

A 
Headache
Arrhythmia
HypoT
Muscle cramps
Line complications (obstruction, infection)
18
Q

How does haemodialysis work?

A

Semipermeable membrane
Blood flows on one side & solution of crystalloid on other side
Diffuse across
Removal of small molecules (urea)

19
Q

What are the Sx of uraemia?

A 
Tremor
Cognitive impairment
Coma
Fits
Urea >45
20
Q

How does haemofiltration work?

A

Blood filtered out of body
Plasma, water & water-soluble substances move across semi-permeable membrane
Later fresh electrolytes replaced

21
Q

What are the complications of peritoneal dialysis?

A 
Peritonitis
Catheter infection
Protein loss
Breathing problems
Back pain
Hyperglycaemia
Hernia
22
Q

How does peritoneal dialysis work?

A

Hypertonic solution
Draws fluid & solutes across peritoneum
Via peritoneal catheter

23
Q

Define CKD?

A

AKA Chronic renal failure;
Permanently impaired renal function/structure for >3months
OR
eGFR <60 for >3mo leads to inability to maintain homeostasis of fluids/U&Es/acid-base

24
Q

What are the causes of CKD?

A

Diabetes
HTN
GN
Idiopathic
Other: RAS, chronic pyelonephritis, reflux nephropathy, PCKD
Systemic: SLE, Vasculitis, myeloma, amyloid

25
Q

What are the RFs for CKD?

A 
DM
HTN
CVD
Hepato-renal syndrome
Structural renal disease
Calculi
Long-term NSAID use
26
Q

What are the Sx of CKD?

A

Asymptomatic
Early: Uraemia, N&V, anorexia, impotence, fatigue, Nocturia, polyuria
Late: Fluid overload, gum hypertrophy, pallor, lemon tinge

27
Q

How is CKD investigated?

A

-Bloods: U&E (↑creatinine, ↓urea), ESR, Glucose, Ca, FBC, Albumin
CREATININE BASED eGFR: ↓↓
-Urine: ACR (↑↑>3), Casts & cells
-Renal USS +/- biopsy: If stage 4-5, refractory HTN, haematuria

28
Q

What does ACR tell you? What are the different levels of severity?

A

If microalbuminuria
A1: Normal-mild ACR <3
A2: Moderate- ACR 3-30
A3: Severe- ACR >30 REFER TO SPECIALIST

29
Q

What are the classifications of CKD?

A 
1: eGFR >90, Kidney damage w/n-↑GFR, ↑BP
YEARLY testing
2. eGFR >60, damage w/mild↓, ↑BP
YEARLY testing
3a. eGFR >45, mod↓, ↑BP, ↑Ca2+ &amp; PO4-, ↓EPO
6mo testing
3b. eGFR >30, mod↓, ↑BP, ↑Ca2+ &amp; PO4-, ↓EPO
6mo testing 
4. eGFR >15, severe↓, ↑K+
3-6mo testing
5. eGFR <15, KIDNEY FAILURE, salt &amp; H20 retention
6w testing
30
Q

How is CKD managed?

A

1) Tx reversible: Stop nephrotoxic
2) Lifestyle: BP, smoking, exercise, diet
Overload: Furosemide
Acidotic: Sodium bicarb
Anaemic: Folic acid/B12
3) BP Control: ACEi/ARB
4) CVD: Statins, Antiplatelet (Aspirin, Apixaban)

31
Q

What are the complications of CKD?

A

Anaemia: ↓EPO = ↓Hb Tx w/recombinant EPO
Renal bone disease:
Metabolic acidosis

32
Q

What are the indications for referral to nephrology due to CKD?

A

Stage 4-5
Sudden ↓eGFR (UTI excluded)
Signif proteinuria (ACR >70)
Persistent microscopic haematuria & <50yo
Functional effects: Anaemia, bone disease, refractory HTN

33
Q

How is ESRD managed?

A

Haemodialysis/ peritoneal dialysis
Recombinant EPO
Renal transplant
Flu & pneumococcal vaccination

34
Q

What are the causes of raised urea?

A 
Catabolic state
High protein intake
GI bleed
Glucocorticoids
Dehydration
Cardiac failure
35
Q

What are the BP aims for someone with CKD?

A

CKD alone = < 140/90

CKD + DM/ACR >70 = <130/80

Yr5 Urology (7 decks)

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