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AIP > Interpreting U and Es > Flashcards

Interpreting U and Es Flashcards

1
Q

What are the causes of increased urea?

A

Caused by increased protein breakdown so dehydration, GI bleeding, trauma, infection, malignancy, high protein intake

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2
Q

What investigations do all patients with AKI require?

A

Urine dipstick
Bloods - FBC, U and E, CRP, Calcium, Phosphate, PTH
VBG - look for low bicarb/metabolic acidosis and hyperkalaemia
Accurate fluid balance chart
Stopping renally excreeted and nephrotoxic drugs

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3
Q

What are the causes of pre-renal AKI?

A

Hypovolaemia/sepsis (most common cause), renovascular disease, cardiorenal failure (increased venous pressure reduces renal perfusion pressure)

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4
Q

What are the main investigations and treatment for pre-renal AKI?

A

Investigate with fluid assessment and renal artery doppler

Treat cause e.g. IV fluids in hypotension

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5
Q

What are the causes of intrinsic renal failure?

A

acute tubular necrosis (ischaemic or nephrotoxic)
Acute interstitial nephritis
Acute glomerulnephitis

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6
Q

What are the main investigations for intrinsic renal failure?

A

Urine dipstick for blood and protein in glomerulonephritis
Urine protein/creatinine ratio (<15mg/mmol = normal, >300mg/mmol = nephrotic)
Nephritic screen: ANA, ANCA, Anti-GBM, hepatitis
Myeloma - protein electrophoresis and serum free light chains
Creatine kinase if rhabdo suspected
Renal biopsy - if nephritic screen positive or glomerulonephritis suspected

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7
Q

What is the treatment for intrinsic renal failure?

A

Treat the cause
Stop causative agents for acute interstitial nephritis
Steroids, diuretics and ace inhibitor may be required for glomerulonephritis

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8
Q

What are the causes of post renal failure?

A

Ureters - stones, stricture, compression
Bladder - neurogenic, bladder calculi, tumour
Urethra - BPH, prostate cancer, stricture

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9
Q

What are the investigations for post renal failure?

A

Renal tract USS

Bladder scan

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10
Q

What is the treatment for post renal failure?

A

Relieve obstruction - catheter if urethral, nephrostomy if ureteric

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11
Q

What are the indications for dialysis in AKI?

A 
AEIOU
Acidosis
Electrolyte abnormalities (Hyperkalaemia)
Intoxicants - methanol etc
Overload
Ureamia - Urea >60 or encephalopathy
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12
Q

What are the common causes of chronic kidney disease?

A

Diabetes (secondary to glomerular disease)
Chronic hypertension
Chronic glomerulonephritis
Polycycstic kidney disease

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13
Q

What is the management of CKD?

A 
General measures - fluid restriction, dietary protein restriction, ACE inhibitor
Treat complications: 
-hypertension - antihypertensives
-Anaemia - ESA + iron supplements
-Oedema - fluid restriction
-Secondary hyperparathyroidism:
--Kidney unable to reabsorb calcium so causes hyperparathyroidism
-- GIve active vit D therapy
--Dietry phosphate restriction
--If calcium low then give supplement tablets
-Acidosis - give sodium bicarb
-hyperlipidaemia - give statin
-Hyperkalaemia - potassium restriction
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14
Q

How does aldosterone effect electrolyte levels?

A

It causes increased sodium reabsorption and increased pottasium excretion in the distal convoluted tubule

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15
Q

What are the symptoms of hyponatraemia?

A

Nausea/vomiting
headache
seizures
reduced consciousness

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16
Q

What are the causes of hyponatraemia?

A

Hypovalaemic - Na+ lost and water follows:
-Urinary sodium >30 - Diuretics, addisons disease (increased K+), kidney injury
-Urinary sodium <30 Na + lost from elsewhere- Dirrhoea/vomiting
Euvolaemic - H2O gained:
-Urinary Na+ >30 - SIADH, Hypothyroidism
-Urinary Na+ <30 - H2O intoxication
Oedematous - retention of water that is disproportionate to the retention of sodium - congestive cardiac failure, hypoalbuminaemia

17
Q

What investigations should be done for hyponatraemia?

A

Plasma osmolality to confirm if true hyponatraemia:
-Low=true
-Normal =False (pseudohyponatraemia due to high lipids
-High = dilutional (due to high glucose)
Urine sodium concentration
Specific tests to confirm causes e.g. synacthen for addisons, TFTs for hypothyroidism

18
Q

What is the management of hyponatraemia?

A

Treat cause
Correct sodium
-seizures consider 3% hypertonic saline with ICU input
-Hypovolaemia - replace lost fluid with 0.9% saline - slowly if chronic e.g. 1L over 12 hours
-Euvolaemic - correct cause
-If SIADH or oedematous then fluid restrict to 1L/day

19
Q

What are the symptoms of hypernatraemia?

A

Thirst
Confusion
Muscle spasms

20
Q

What are the causes of hypernatraemia?

A

Euvolaemic - iatrogenic e.g. too much IV sodium containing fluids
Hypovolaemic:
-Small volumes of concentrated urine - dehydration
-Normal urine - diabetes insipidus, osmotic diuresis e.g. DKA

21
Q

What are the investigations for hypernatraemia?

A

Urine and serum osmolality

Fluid deprivation test to confirm diabetes indipidus

22
Q

What is the management of hypernatraemia?

A

Treat ause
Sodium correction:
-Most patients - 5% dextrose, slowly if chronic
-Signs of volume depletion - replace lost fluid with 0.9% saline

23
Q

How do insulin and catecholamine increase K+ cellular uptake?

A

They cause stimulation of the ATPase Na+/K+ pump

24
Q

What are the symptoms of hypokalaemia?

A

Arrhythmias
Tremour
Muscle weakness/cramps
Constipation

25
Q

What are the causes of hypokalaemia?

A

Increased renal loss:
-Diuretics (except potassium-sparing diuretics)
-Endocrinological (steroids, Cushing’s syndrome, hyperaldosteronism)
-Renal tubular acidosis
Intestinal loss:
-Intestinal fluid loss (vomiting/dirrhoea)
Increased cellular uptake:
-Salbutamol
-Insulin
-Alkalosis

26
Q

How do you manage hypokalaemia?

A

> 2.5mmol/L - potassium supplementation e.g. sando K 2 tablets 3/7
<2.5mmol/L - 40mmol/L potassium chloride in 1L 0.9% saline over 4-6 hours (do not give >10mmol/hr outside ITU)
Treat cause

27
Q

What are the symptoms of hyperkalaemia?

A

Arrhythmias
Lethargy
Muscle weakness

28
Q

What are the causes of hyperkalaemia?

A 
Reduced renal excretion:
-Acute/chronic kidney injury
-Drugs (potassium-sparing diuretics, ACEi, NSAIDs)
-Aldosterone deficiency (addisons)
Increased K+ load:
-Iatrogenic
-Massive transfusion
Celluar release:
-Acidosis
-Tissue breakdown e.g. rhabdo, haemolysis
29
Q

What is the management of hyperkalaemia?

A

ECG an 3 lead cardiac monitor
-changes flat P waves, wide QRS, tall T waves
Calcium gluconate - 10ml 10% IV over 10 mins
-Lasts 30-60 mins
Actarapid insulin - 10 units in 250ml 10% dextrose IV over 30 mins
Calcium resonium - only treatment that actually removes potassium from body - give with lactulose as causes constipation
Treat cause

30
Q

What is the physiology behind calcium levels in the body?

A

Vitamin D is required for calcium absorption from the gut

Parathyroid hormone causes reabsorption of calcium in the kidneys and reabsorption from bone

31
Q

What are the causes of Hypocalcaemia?

A

Increased renal excretion (Increased phosphate and increased PTH)
-Drugs (loop diuretics)
-Chornic kidney disease
-Rhabdo/tumour lysis syndrome (free phosphate binds calcium)
PTH related (High phosphate, low PTH)
-Hypoparathyroidism
-Hypomagnesaemia
-Pseudohypoparathyroidism (resistant to PTH)
Increased deposition/reduced uptake
-Bisphosphonates
-Vit D deficiency

32
Q

What is the management of hypocalcaemia?

A

In severe cases (<1.9mmol/L or symptomatic) give 10ml 10% calcium gluconate over 30 mins diluted
Mild - calcium supplements
Treat cause e.g. vit D deficiency replace, calcium and vit D deficiency give Adcal-D3

33
Q

What are the causes of hypercalcaemia?

A 
Decreased renal excretion
-Drugs - thiazide diuretics
Increased release from bones 
-Bony mets (Increased ALP)
-Myeloma (normal ALP)
-Sarcoidosis
-Thyrotoxicosis
Excess PTH:
-Primary hyperparathyroidism or tertiary hyperparathryroidism
Excess Vit D intake
Dehydration is also common cause
34
Q

What are the investigations for hypercalcaemia?

A

Initial: - Renal function, ALP, PTH, Phosphate
Myeloma screen - bence jones proteins
Serum ACE - if suspect sarcoidosis
Isotope bone scan if thinking bony mets

35
Q

What is the management of hypercalcaemia?

A

Treat cause
Rehydrate - continous 0.9% saline at 1L/4-6hrs
If severe >3.5 or symptomatic - medical emergency - also give bisphosphonates e.g. pamindronate 30-90mg IV depending on severity

AIP (19 decks)

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