metabolic mc1 Flashcards
define AKI
Increase in serum creatinine by ≥0.3 mg/dL (≥26.5 micromol/L) within 48 hours; or
Increase in serum creatinine to ≥1.5 times baseline, which is known or presumed to have occurred within the prior seven days; or
Urine volume <0.5 mL/kg/h for six hours
what does KDIGO leave out for AKI
GFR (apart from in children)
AKI stage 1
Increase in serum creatinine to 1.5 to 1.9 times baseline, or increase in serum creatinine by ≥0.3 mg/dL (≥26.5 micromol/L), or reduction in urine output to <0.5 mL/kg per hour for 6 to 12 hours.
AKI stage 2
Increase in serum creatinine to 2.0 to 2.9 times baseline, or reduction in urine output to <0.5 mL/kg per hour for ≥12 hours.
AKI stage 3
Increase in serum creatinine to 3.0 times baseline, or increase in serum creatinine to ≥4.0 mg/dL (≥353.6 micromol/L), or reduction in urine output to <0.3 mL/kg per hour for ≥24 hours, or anuria for ≥12 hours, or the initiation of renal replacement therapy, or, in patients <18 years, decrease in eGFR to <35 mL/min per 1.73 m2.
dehydrated AKI treatment/pre renal
IV fluid therapy – fluid challenge = 500 mL 0.9% NaCl over fifteen minutes
Withdrawal of nephrotoxins
Withholding of hypotensive agents and diuretics
Withhold atorvastatin
causes of hyperK
Reduced aldosterone secretion
aldosterone resistance
Reduced distal sodium and water delivery as occurs in effective arterial blood volume depletion
Acute and chronic kidney disease in which one or more of the above factors are present
spironolactone MOA
It competes with aldosterone for receptor sites in the distal renal tubules, increasing sodium chloride and water excretion while conserving potassium and hydrogen ions; may block the effect of aldosterone on arteriolar smooth muscle as well.
spironolactone active metabolite
canrenone
only diuretics that do not act at the luminal membrane of the tubular cells
spiro
eple
what upregulates Enac
ALDOSTERONE
what is required for spiro and epel to work
aldosterone
what enhances the work of spiro and epel
hyperaldosterone
spironolactone indications
Systolic heart failure
Resistant hypertension
Temporary treatment of Conn’s syndrome
Liver failure (oedema)
first line diuretic for ascites with liver failure
spironolactone
would you use spironolactone in primary hyperaldosterone
ye while waiting for surgery/cant have surgery/establishing diagnosis
spironolactone adverse effects
Hyperkalaemia Gynaecomastia Liver impairment Jaundice Stevens–Johnson syndrome (a T cell-mediated hypersensitivity reaction)
when not to use spironolactone
Severe renal impairment
Hyperkalaemia
Addison’s disease
Pregnant or lactating women
why can you use spironolactone in addisons
no aldosterone
why not to use spironolactone in pregos
crosses placenta and milk
spironolactone interactions
ACEi and K supplement
loop diuretics MOA
Inhibits reabsorption of sodium and chloride in the ascending loop of Henle and distal renal tubule, interfering with the chloride-binding co-transport system
what do loop diuretics cause the excretion of
excretion of water, sodium, chloride, magnesium, and calcium.
loop diuretics side effecs
Dehydration Hypotension/Hyponatraemia/Hypokalaemia/Hypochloraemia/Hypocalcaemia/Hypomagnesaemia Metabolic alkalosis Gout Deafness Tinnitus
