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Kidney Flashcards

1
Q

What is renal blood flow

A

20% of CO

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2
Q

What are proximal tubular cells susceptible to

A

Hypotension and hypoxia

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3
Q

Where is erthropoietin produced

A

Kidneys (px can be anaemic if CKD)

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4
Q

What are the functions of the kidneys

A 
Excretion of electrolytes
Clearance of waste products 
Receptor sites for hormones:
ADH, aldosterone, ANP, PTH
Gluconeogenesis
Production of hormone: renin, vitamin D, erythropoietin, prostaglandins
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5
Q

What are pre-renal causes of AKI

A

Hypoperfusion - anything that causes shock, cardiac output

Renal artery stenosis

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6
Q

What are renal causes of AKI

A

Glomerulonephritis
Diabetes
PKD
Toxins - gentamycin, NSAIDs (reduce prostaglandin production, which reduce renal perfusion)

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7
Q

What are post renal causes of AKI

A

Anything in urinary tract
Takes 2 weeks for damage
Swollen kidney with no urine output is a medical emergency

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8
Q

What are the effects of AKI

A

Fluid overload

Oedema (pulmonary - breathlessness lying flat, pleural effusion, peripheral, sacral, ascites)

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9
Q

What investigations should be undertaken for AKI

A

Chest X-Ray
GFR
ECG for heart failure
Weight change

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10
Q

How is hyperkalameia treated

A

Hyperkalaemia: Treat with calcium gluconate, then insulin (pushes potassium into cells), or calcium resonium for long term treatment. Dialysis.

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11
Q

What are the ECG signs for different hyperkalameia

A

K 5.5-6.5 - Peaked T waves, prolonged PR segment
K 6.5-8 - Loss of P wave, prolonged QRS complex, ST segment elevation, ectopic beats and escape rhythms
K > 8 - Progressive widening of QRS complex, sine wave, VF, asystole, axis deviations, bundle branch block, fascicular blocks

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12
Q

What are signs of metabolic acidosis

A 
Metabolic acidosis: exacerbates potassium issues 
Typical ABGs
pH > 7.3
pCO2 Low
pO2 normal to high
HCO3 low
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13
Q

What is uraemia

A

Retention of metabolic waste products (sulphate, urea, ammonia, creatinine, phosphate)

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14
Q

What are the symptoms of metabolic acidosis

A

breathless, tachypnoeic, nausea, non-specifically unwell

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15
Q

What are the effects of uraemia

A

Pericarditis, pleurisy, encephalopathy

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16
Q

How is AKI diagnosed

A 
Serum creatinine (only rises after losing more than 50% of kidney function) >26.5 in less than 48 hours or rises to 1.5 fold from baseline in the preceding 7 days
Urine output less than 0.5ml/kg/h for 6 hours
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17
Q

What are life threatening complications of AKI

A 
Life threatening pulmonary oedema
Severe metabolic acidosis
Severe hyperkalaemia
Uraemic pericarditis
Uraemic encephalopathy
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18
Q

Where are the insertion sites for dual lumen catheters for RRT

A

Insertion sites:
Internal jugular vein
Femoral vein
Subclavian vein

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19
Q

What is ideal body water composition

A

TBW = 60% ideal
40% intracellular
20% extracellular (15 interstitial fluid and 5 intravascular)

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20
Q

What is thirst stimualated by

A

Increases in plasma osmolality of 1-2% (normally between 280-300)
Decline in plasma volume of 10-15%
Baroreceptor input, angiotensin II

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21
Q

What is ADH and what does it co

A

Binds to V2 receptors on basolateral membrane of principle membrane along distal convoluted tubules and increases AQP2 expression of luminal membrane
Leads to arteriole vasoconstriction

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22
Q

What is ANP

A

Primarily released from atria - in response to volume expansion

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23
Q

What is BNP

A

Released by ventricles - in response to stretch

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24
Q

What do ANP and BNP promote

A

Dilatation of afferent arterioles and constrict the efferent arterioles (higher pressure in glomerulus and increase GF)
Reduce Na reabsorption in the DCT
Inhibit renin secretion
inhibit renal sympathetic tone

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25
What is hyponatremia
Na<135 mmol
26
How does hyponatremia occur
Results from intake and subsequent retention of water. Excess of water in relation to Na - impairment in renal water excretion, most often due to an inability to suppress ADH secretion Depletion of total body Na in excess of concurrent body water losses
27
What are the 3 classifications of hyponatremia
Hypovolaemia Euvolaemia (urine Na >30 mmol/L) Hypervolaemia
28
What are the causes of hypovalaemic hyponatremia
``` Extrarenal losses (urine Na<25mmol) Dermal losses GI losses 3rd space loss (pancreatitis0 Renal losses (urine Na>30mmol/L) Diuretic therapy Cerebral salt wasting Primary adrenal insufficiency ```
29
What are the causes of euvolaemic hyponatremia
``` Water intoxication - primary polydipsia, excess IV hypotonic fluids Hypothyroidism Hypopituitarism Pregnancy SIADH ```
30
What are the causes of hypervolaemia hyponatremia
``` Urine Na < 25mmol Congestive cardiac dysfunction Cirrhosis with ascites Nephrotic syndrome Urine Na > 30 mmol/L - chronic kidney disease ```
31
What is SIADH
Syndrome of inappropriate antidiuretic hormone secretion is characterized by excessive unsuppressible release of antidiuretic hormone (ADH) either from the posterior pituitary gland, or an abnormal non-pituitary source. Unsuppressed ADH causes an unrelenting increase in solute-free water being returned by the tubules of the kidney to the venous circulation
32
What is the treatment for hypovolemia hyponatremia
Correct volume depletion e.g. IV 0.9% saline
33
What is the treatment for euvolemia hyponatremia
Treat underlying cause, fluid restriction
34
What is the treatment for hypervolemia hyponatremia
Treat underlying cause, fluid restriction (vasopressin receptor antagonist)
35
What occurs in the brain in hyponatremia
Osmotic gradient between EC and IC fluid within the brain: water moves into cells and raises intracranial pressure due to oedema - neuro symptoms
36
When is agressive therapy for hyponatremia indicated
Severe symptoms Acute hyponatremia Goal - raise serum Na by 4-6 mmol/L over few hours, no more than 8 mmol/L/day Hypertonic 3%
37
What is the risk of rapid correction in hyponatremia
Risk of central pontine myelinolysis - damage to oligodendrocytes
38
What is hyperatremia
Hypernatremia Na > 145mmol/L From net water loss or hypertonic Na gain Increase in plasma tonicity pulls water out of cells ,resulting in a decrease in intracellular volume
39
What is severe hyperatremia
Na > 145 mmol/L
40
What are the symtpoms of hyperatremia
Thirst, anorexia, weakness, stupor, seizures, coma
41
What are the two types of hyperatremia
Unreplaced water loss and sodium overload
42
What is unreplaced water loss hyperatremia caused by
``` Insensible and sweat losses GI losses Central diabetes insipidus Nephrogenic diabetes insipidus Osmotic diuresis (high glucose) Poor water intake ```
43
What is sodium overload hyperatremia caused by
Admin of high salt load | Hyperaldosteronism
44
What is the treatment of chronic hyperatremia
treat underlying cause, use of hypotonic fluid (5% dextrose), lower Na by maximum of 10 mmol/L day
45
What is the treatment for acute hyperatremia
Hypotonic fluid, lower Na by 1-2 mmol/L per hour to restore Na levels within 24 hours. Acute increase in plasma Na can lead to irreversible neuro injury
46
What is hypokalemia
Hypokalaemia K<3.5 mmol/L K enters the body via oral intake or IV, largely stored in the cells, then excreted in the urine
47
What the the 3 caues of hypokalaemia
Decreased K intake Increased K entry into cells Increased losses - GI/urine
48
What causes increased K entry into cells
``` Extracellualr pH rise Increased inslin Elevated b-adrenergic activity Hypothermia Drugs e.g. antipsychotics ```
49
What causes increased GI losses of K
Vomiting Diarrhoea Laxative abuse
50
What causes increased urinary losses of K
Diuretics Priamry mineralocorticoid excess Renal tubular acidosis Drugs .e.g Amphotericin B
51
What are the ECG changes in hypokalaemia
``` Flat T waves U waves ST depression PR interval prolonged Prolonged QT interval ```
52
What is the treatment for hypokalemia
Correct Mg levels K replacement If IV maximum 10-20 mmol/hr and cardiac monitoring
53
What is hyperkalemia
K>5.5
54
What are the two causes for hyperkalemia
Increased release from cells | Reduced urinary excretion
55
What are the causes of increased K release from cells
``` Pseduohyperkalemia Metabolic acidosis Insulin deficiency Increased tissue catabolism Beta blockers Exercise Hyperkaelmic periodic paralysis ```
56
What are reduced urinary excretion causes of hyperkalemia
Acute and chronic kidney disease Reduced aldosterone secretion Reduced response to aldosterone
57
What are the symptoms of hyperkalemia
Paraesthesia Muscle weakness Arrhythmias
58
What are the ECG changes of hyperkalemia
``` any ECG changes are medical emergencies Tall peaked T waves Shortened QT interval PR interval lengthening QRS widen P waves disappear - Sine wave ```
59
What is the treatment for hyperkalemia
IV calcium gluconate - antagonise membrane action of high K IV insulin with glucose - drive K into cells Remove K from body: consider loop diuretics Consider haemodialysis Other therapies to drive K into cells: Sodium bicarbonate, beta agonists
60
What are symptoms of hypovolemia
GI losses, thirst, lethargy, postural dizziness, reduced urine volume, confusion
61
What are examination findings of hypovolemia
pulse is fast and weak, BP postural drop > 20mmHg, loss of skin turgor, sunken eyes, dry mucous membranes
62
What are symptoms of hypervolemia
breathlessness, peripheral oedema, weight gain, abdominal bloating, confusion
63
What are examination findings of hypervolemia
``` Pulse - can be fast, bounding BP can be high, can be low Skin turgor generally maintained Peripheral oedema JVP can be elevated Can have ascites ```

Supporting Life (14 decks)

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