AKI + CKD (Acute Kidney Injury + Chronic Kidney Damage)

Question 1

What is AKI?

Name 2 substances in plasma that rise rapidly in AKI

Answer 1

Deterioration of renal function over hours/ days

Plasma Urea and Creatine

Question 2

What is AKI usually associated with?
Is it reversible or irreversible?

What are 3 consequences of AKI?

Answer 2

• Usually associated with Oliguria
• Usually reversible
• Hyperkalaemia
• Volume overload
• Metabolic acidosis

Question 3

In terms of Serum Creatinine, compare the 3 stages of AKI

Answer 3

1: Serum Cr 1.5-1.9 times baseline
2: Serum Cr 2.0-2.9 times baseline
3: Serum Cr 3.0 times baseline

Question 4

Briefly compare the 3 types of causes of AKI

Answer 4

Pre-renal: Decreased blood flow (Commoner, 90%)

Intrinsic: Direct damage to renal tissue

Post-renal: Obstruction of flow of urine

Question 5

List 3 causes of Pre-Renal AKI

Answer 5

• Shock (Septic, Cardiogenic, Hypovolaemic)
• Renal Artery Stenosis/ Embolism
• NSAIDs and ACE Inhibitors (impair mechanisms of renal autoregulation)

Question 6

List 4 causes of Intrinsic AKI (A rare cause)

Answer 6

• Acute Tubular Necrosis (Ischaemia, Rhabdomyolysis, Drugs and toxins)
• Acute Interstitial Nephritis (Drugs, infections, hypercalcaemia)
• Glomerular disease (Acute glomerulonephritis, rapidly progressive glomerulonephritis)
• Vascular disease (Vasculitis)

Question 7

Lis 4 causes of Post-Renal AKI

Answer 7

• Tumour (Bladder, prostate)
• Benign Prostatic Hyperplasia
• Stone (Must be bilateral)
• Retroperitoneal fibrosis-> Ureteral obstruction

Question 8

How is AKI managed?

Answer 8

• Fluid replacement to optimise blood flow to kidneys (Not Dextrose, as we want to keep fluid in ECF)
• Urinary/ Suprapubic catheter to relieve bladder outflow obstruction
• If Ureters are obstructed, Drainage tube/ Nephrostomy is inserted above obstruction

Question 9

What is CKD?

How is it different to AKI?

Answer 9

An adaptive response of kidneys to loss of functioning nephrons

• Loss of renal function over months to years
• Usually irreversible, as renal tissue replaced by scar tissue

Question 10

What are 2 main things to measure in CKD?

Answer 10

• BP

- Urine Analysis

Question 11

What is Hydronephrosis?

Answer 11

Obstruction of ureters causes urine to back up into kidneys causing swelling

Question 12

What are 7 Risk factors for CKD?

Answer 12

Modifiable;

• Lifestyle
• Smoking
• Obesity
• Lack of exercise
• Uncontrolled diabetes
• Hypertension
• Proteinuria

Question 13

Describe how impaired renal function leads to increase bone resorption in 2 ways

Answer 13

1;

• Reduced PO4 excretion-> Increased Plasma PO4
• Increased PTH secretion-> Increased bone resorption

2;

• Decreased Calcitriol production-> Reduced gut Ca absorption + Impaired bone mineralisation
• Impaired bone mineralisation-> Increased bone resorption
• Reduced gut Ca absorption-> Reduced plasma Ca-> Increased PTH secretion->Increased Bone resorption

Question 14

List 7 symptoms of End Stage Renal Dialysis

Answer 14

• Tiredness
• Difficulty sleeping
• Difficulty concentrating
• Nausea, vomiting, reduced appetite
• Restless leg/ cramps
• Itching
• Sexual dysfunction, reduced fertility

Question 15

What are the 5 stage of CKD

Answer 15

Stage 1: GFR of 90 or higher

Stage 2: GFR 60-89

Stage 3a: GFR 45-59
Stage 3b: GFR 30-44

Stage 4: GFR 15-29

Stage 5: GFR <15