Question 1

Pre-renal causes of AKI

Accepted Answer

Reduced perfusion as a result of either circulatory changes or a reduction in glomerulus perfusion pressure leading to a reduced eGFR:

Hypovolaemia (haemorrhage, dehydration, burns etc.)

Hypotension (shock)

Fluid overload (cirrhosis, CCF, nephrotic syndrome)

Reduced cardiac output (shock, MI, arrhythmia, CCF)

Vascular changes (renal stenosis or thrombosis)

Drugs such as ACE-I’s and NSAIDS

Question 2

Renal (Intrinsic) causes of AKI

Accepted Answer

Anything which impacts the parenchyma of the kidneys and may occur as a result of chronic pre or post renal pathologies:

Glomerular damage (glomerulonephritis, IgA nephropathy, thrombosis, uraemic syndrome

Acute interstitial nephritis

Acute tubular necrosis

Vasculitis

Question 3

Post-renal causes of AKI

Accepted Answer

Anything that obstructs urine flow below level of renal calyx: ``` Stones Clots Malignancy BPH Strictures Retroperitoneal fibrosis ```

Question 4

Criteria for AKI stage 1

Accepted Answer

Rise in creatinine of at least 26 mol/L in 48 hours OR Creatinine rise to 50%+ of baseline in 7 days OR Urine output < 0.5ml/Kg/Hr for 6+ hours

Question 5

Criteria for AKI stage 2

Accepted Answer

Creatinine 2x baseline OR Urine output < 0.5ml/Kg/Hr for 12+ hours

Question 6

Criteria for AKI stage 3

Accepted Answer

``` Creatinine 3x baseline OR Rise of 1.5 baseline to at least 355 micromol/L OR Urine output < 0.3ml/Kg/Hr for 24 hours OR Anuria for 12+ hours ```

Question 7

Complications of AKI

Accepted Answer

``` Uraemia Hyperphosphataemia Hyperkalaemia Prolonged chronic kidney disease Metabolic acidosis Electrolyte imbalances ```

Question 8

Investigating AKI

Accepted Answer

``` U&E's with creatinine FBC CRP LFTs - hepatorenal syndrome? Clotting Creatine Kinase - rhabdomyolysis? VBG ``` Urine dip and cultures Monitor urine output Fluid challenge ECG especially if potassium deranged Renal US - if obstruction suspected or no cause obvious CT/MRI is US suggests obstruction or not cause obvious

Question 9

CKD symptoms

Accepted Answer

``` Fatigue Nocturia Hypertension Hameaturia and/or proteinuria Nausea and vomiting Itching Breathlessness ``` ``` Late stages: Seizures Reduced GCS Kussmaul's respiration Muscle twitching ```

Question 10

CKD Complications

Accepted Answer

Anaemia from erythropoietin deficiency

Renal osteodystrophy due to PTH rising in response to hypokalaemia and hyperphosphataemia

Vitamin D deficiency

Cardiovascular disease

Protein malnutrition

Metabolic Acidosis

Oedema

Hyperkalaemia

Question 11

CKD Stages + eGFR + Symptoms

Accepted Answer

Stage 1 - Damage but eGFR normal - Asymptomatic

Stage 2 - Damage with eGFR 60-89 - Asymptomatic

Stage 3a - eGFR 45-59 - Can be asymptomatic

Stage 3b - eGFR 30-44 - Anaemia

Stage 4 - eGFR 15-29 - Electrolyte disturbances

Stage 5 - eGFR < 15 - Significant complications

Question 12

Causes of CKD

Accepted Answer

``` Diabetes Interstitial disease Glomerular disease Hypertension Systemic inflammatory disease Congenital conditions Renal artery stenosis ```

Question 13

Treating CKD

Accepted Answer

Stage 1-2 with no uraemia

1) ACE-I/ARB or non-dihyrdopyridine CCB
2) Statin

Additional HTN control if needed
Glycaemic control if needed

Stage 3-4 with no uraemia

Same as above + education on renal replacement (e.g. dialysis, transplantation)

Stage 5 OR any stage with uraemia

1) Dialysis
2) Kidney Transplant

If anaemic: Erythropoietin stimulating agent, Fe

If hyperparathyroidism: phosphate binder, calcium mimetic, vitamin D

Question 14

Investigating CKD

Accepted Answer

eGFR - stage of CKD U&E's - electrolytes, especially K+ ECG - arrhythmia etc. Bone profile - hyperparathyroidism, hypocalcaemia, hypoalbuminaemia FBC - anaemia Urinalysis - protein and blood in urine HbA1c - glucose control Lipids - lipid control Renal US +/- Bx

Question 15

ADPKD Symptoms

Accepted Answer

``` Hypertension Abdominal/flank pain Haematuria Palpable kidneys Hepatomegaly Headache Heart murmur Hernia ```

Renal Flashcards