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Renal + Urology > CKD + AKI > Flashcards

CKD + AKI Flashcards

1
Q

What is the definition of CKD?

A

Abnormality of kidney structure or function, present for >3 months, with implications for health

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2
Q

What is the definition of AKI?

A

Sudden deterioration of function in absence of prior abnormality

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3
Q

Causes of CKD

A

Diabetic nephropathy

Glomerulonephritis

HTN

Systemic disease (SLE, vasculitis, myeloma)

Renal artery stenosis

Polycystic kidney disease

Pyelonephritis

Urinary tract obstruction (inc prostatic disease)

HF

NSAIDs

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4
Q

How does CKD present?

A

HTN

Incidental findings on bloods

Symptoms usually late stage

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5
Q

Indications for screening pts at risk of developing CKD

A

Diabetes

HTN

CV disease

Nephrotoxic drugs (NSAIDs, lithium)

Structural renal disease

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6
Q

What causes a high serum urea?

A

Catabolic state

High protein intake

GI bleed

Dehydration

CV failure

Reduced renal function

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7
Q

What causes a low serum urea?

A

Liver failure

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8
Q

What causes a high serum creatinine?

A

Reduced renal function

Large muscle mass (young, male, muscular)

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9
Q

What causes a low serum creatinine?

A

Low muscle mass (elderly, wasting, females)

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10
Q

How do you calculate eGFR?

A

Calculated from blood results + demographic data (age, gender, race)

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11
Q

How is proteinuria measured + why is it important?

A

Measured in urine sample as protein: creatinine ratio (PCR) or albumin: creatinine ratio (ACR)

Guides management

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12
Q

How would you investigate the cause of CKD?

A

Haematology/ biochem

Urine dip + MC+S

Immunology screen

Renal USS +- biopsy

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13
Q

What is the normal function of the kidneys?

A

Excrete substances

Homeostasis - fluid balance, BP, acid-base

Endocrine - erythropoietin, bone metabolism

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14
Q

Metabolic complications of CKD

A

Anaemia

Bone mineral disorder (low Ca, high PO4, high PTH

Metabolic acidosis (low bicarb)

Hyperkalaemia

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15
Q

Clinical features of CKD

A

Renal: fluid retention, polyuria, polydipsia

CV: HTN, pulmonary oedema, vascular disease, dyslipidaemia

GI: anorexia, N+V, peptic ulcers

Neuro: neuropathy

Derm: pruritis, pigmentation

Endocrine: amenorrhoea, reduced fertility

MSK: bone pain, fractures

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16
Q

When to refer pt to renal care

A

eGFR <30

Progression

Uncertain cause

Possible hereditary disease

Significant proteinuria

Haematuria + proteinuria

17
Q

Management of CKD

A

BP control

CVS risk reduction - statins

Diet

Vit D, folic acid, iron, phosphate control

Bicarbonate supplements

Dialysis

18
Q

What are the RF for progression?

A

Lower eGFR

BP control

Proteinuria

Smoking

Hyperglycaemia

Obesity

Nephrotoxic drugs

19
Q

What diet is recommended with CKD?

A

Restrict salt

Restrict calories

Restrict phosphate + potassium

20
Q

What is the target BP for CKD?

A

Less than 140/90

21
Q

How to manage HTN in CKD?

A

ACEi or ARBs except in renal artery stenosis

22
Q

Which drugs can cause hyperkalaemia in CKD?

A

ACEi, ARBs, amiloride, spironolactone, potassium

23
Q

When is dialysis needed?

A

When eGFR is <10

24
Q

What are the options for ESRD management?

A

Haemodialysis

Peritoneal dialysis

Kidney transplant

Conservative care

25
Q

What is CAPD vs APD?

A

CAPD: continous ambulatory peritoneal dialysis.

4x 2-3L exchanges per day

APD: automated PD - while asleep at night

26
Q

What are the symptoms of AKI?

A

Anorexia

Headache

N+V

Arrhythmias

Change in BP

Pain in flanks

27
Q

What are the U+E findings for CKD?

A

Hyperkalaemia

Hypercalcaemia

Hyponatraemia

28
Q

Pre renal causes of AKI

A

Ischaemia, D+V, sepsis, renal artery stenosis

29
Q

Intrinsic causes of AKI

A

Damage to glomeruli, interstitialRhabdomyolysis

30
Q

Post renal causes of AKI

A

Kidney stones, BPH, external compression of ureter

31
Q

S+S of AKI

A

Confusion, N+V, oliguria, haematuria

32
Q

Investigations + results for AKI

A

FBCs (anaemia indicates acute on chronic)U+E (K+, creatinine + urea) ECGUrinalysis, ABGUSSCXR

33
Q

Management of AKI

A

Treat sepsis, stop nephrotoxins (NSAIDs, gentamicin, ACEi, ARBs, diuretics, metformin, lithium, digoxin, heparin), optimise BP Fluids IV calcium gluconate if hyperkalaemic Insulin + dextrose transfusion Treat oedema with furosemide, GTN, CPAPTreat acidosis = IV bicarbonate

34
Q

Criteria used to define AKI

A

KDIGO/ RIFLE:

1) >50% rise in serum creatinine within last 7 days
2) Increase in creatinine by >26.5 within 48hrs
3) urine output <0.5ml/kg/hr for more than 6hrs

35
Q

Severity of AKI

A

1: 1.5-2x baseline creatinine 2: 2-3x baseline 3: >3x baseline

Renal + Urology (6 decks)

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