CPL renal

Question 1

what is the definition of acute kidney injury?

Answer 1

rapid reduction in kidney function over hours to days as measured by serum urea and creatinine and leading to failure to manage and mantain fluid,e lectrolyte and acid homeostasis

Question 2

what are the three diagnostic measurements for diagnosing acute kidney injury?

Answer 2

rise in creatinine over 26L/48 hours
rise in creatinine of 1.5x baseline
- urine output under 0.5ml/kg/hour

Question 3

what are risk factors for developing AKI?

Answer 3

• age over 75
• CKD
• cardiac failure
• peripheral vascular disease
• chronic liver disease
• diabetes
• ACE Inhibitors/ NSAIDS/ aminoglycosides
• intraperitoneal surgery
• sepsis
• poor fluid intake
• history of urinary symptoms

Question 4

what are the causes of AKI split into?

Answer 4

Pre renal
renal
post renal

Question 5

what are pre-renal causes of AKI?

Answer 5

hypoperfusion:

hypotension, sepsis, hypovalaemia, renal artery stenosis, diarrhoea, heart failure, NSAIDS, ACE inhibitors,

Question 6

What are renal causes of AKI?

Answer 6

tubular acute necrosis often due to pre-renal damage of nephrotoxic drugs, radial contrast, myogloobinuria

autoimmune causes such as SLE
nephrotic/nephritic syndrome

interstitial: drugs, lymphoma, rhabdomyolysis, tumour lysis syndrome

vasculitis
hypertension
emboli

Question 7

what are post renal causes of AKI?

Answer 7

urinary tract obstruction

BPH

Question 8

what will urinary sodium in prerenal AKI?

Answer 8

<20 because the kidneys are still working well enough the resorb

Question 9

what are indications for renal replacement therapy in AKI?

Answer 9

• acidosis <7.2
• electrolytes: K>7
• Ingested toxins (barbiturates, lithium, alcohol, salicyltes)
• Oedema
• Uraemia

Question 10

what are possible signs of AKI?

Answer 10

• fatigue
• malaise
• rash
• joint pain
• nausea
• chest pain
• palpitations
• SOB
• abdo pain

Question 11

what is the definition of chronic kidney disease?

Answer 11

impaired renal function for over 3 months based on abnormal structure or function OR
GFR under 60 for over 3 months

Question 12

what happens at stage 3 of CKD?

Answer 12

PTH starts increasing making bone disorders more likely

Question 13

what are causes of CKD?

Answer 13

• diabetees
• glomerulonephritis
• hypertension
• pyelonephritis
• PCKD

Question 14

how does IgA nephropathy present?

Answer 14

1-2 days after a URTI

Question 15

how does post strep glomeruonephritis present?

Answer 15

7 days after a strep infection

Question 16

what is good pastures syndrome?

Answer 16

A cause of glomerulonephritis due to antibodies against IV collagen.

Question 17

how can you investigate EGFR using the diet in renal disease equation?

Answer 17

- use 
C- serum creatinine
A- age
G- gender
E- ethnicity

Question 18

what are the blood findings in CKD?

Answer 18

• high phosphate
• low calcium
• low bicarbonate
• high PTH after stage three

Question 19

what are complications of CKD?

Answer 19

renal bone disease
normochromic normocytic anaemia
- increase CVS risk

Question 20

why can kidney disease cause low active vit D levels?

Answer 20

1 hydroxylation takes place in the kidney

Question 21

what is the management of CKD?

Answer 21

• blood pressure control (ACE inhibitors)
• treat high PTH with phosphate binders and vit D supplements
• statins and aspirin
• EPO if anaemic
• bicarbonate supplements for acidosis
• loop diuretics

Question 22

what is CKD dangerous for the CVS system?

Answer 22

CKD has phosphate retention. this causes FGF23 release which is cardiotoxic

Question 23

why can CKD patients get acidosis?

Answer 23

A loss of bicarbonate as normally this is made in the PCT

Question 24

why are there platelet abnormalities in CKD?

Answer 24

increased homocysteine makes a prothrombotic tendency