GUM Flashcards
Define chronic kidney disease
Abnormal kidney structure or function for more than 3 months which has implications on health
In what 2 ways is CKD classified?
GFR and albumin:creatinine ratio
Causes of CKD
Diabetes Hypertension Glomerulonephritis Long term NSAID use Heart failure
Symptoms of CKD
People may be asymptomatic. Fluid overload eg SOB, oedema Anorexia Nausea and vomiting Pruritus Fatigue
Management of CKD
Consider referral to nephrology
ACEI/ARB especially if diabetic or uncontrolled hypertension
Improve diabetic control
Manage symptoms e.g, loop diuretics for oedema
Definition of AKI
Sudden decline in renal function leading to an ability to excrete waste products and regulate fluid and electrolytes.
Pre-renal causes of AKI
Hypovolaemia e.g. haemorrhage, sepsis Shock MI Thrombus Renal artery stenosis Antihypertensive drugs
Renal causes of AKI
Drugs Vasculitis Glomerulonephritis Acute tubular necrosis Interstitial nephritis
Drugs causing AKI
Aminoglycocides e.g. gentamicin Diuretics ACEi/ARB NSAIDs IV contrast Chemotherapy
Post-renal causes of AKI
Post-operative Neurogenic bladder e.g. cauda equina, MS Renal stones Enlarged prostate Urethral stricture Urinary tract tumours and malignancy
Complications of AKI
Chronic renal impairment Prolonged hospital stay Hyperkalaemia Pulmonary oedema Acidaemia Pericarditis Uraemic encephalopathy
Management of AKI
Treat underlying cause
e.g.
Fluids for hypovolaemia
Review medication
Treat emergencies!
Name some emergency complications of AKI and how to treat them
Pulmonary oedema - frusemide / loop diuretics
Hyperkalaemia - IV calcium gluconate, insulin and dextrose, salbutamol nebulisers
Acidosis - sodium bicarbonate
Stages of AKI
Stage 1:
Creatinine - rise of 26 in 48h, or 1.5-1.9x baseline
Urine - <0.5ml/kg/h for >6h
Stage 2:
Creatinine - Rise 2-2.9x baseline
Urine - <0.5ml/kg/h for >12h
Stage 3:
Creatinine - Rise >3x baseline, rise of >354, or renal replacement therapy being needed
Urine - <0.3ml/kg/h for 24h, or anuria for 12h
Strategies for preventing AKIs
Withhold/stop unnecessary medication
Encourage hydration
Identify those at risk e.g. elderly, polypharmacy, single kidney
