RENAL Flashcards
What is acute kidney injury (AKI)?
Syndrome of decreased renal function measured by serum creatinine or urine output, occurring over hours-days
What is creatinine in AKI?
> 1.5x baseline within 7 days
What is urine output in AKI?
<400ml/day
What is a pre-renal cause of AKI?
decreased blood flow to the kidney
What is a post-renal cause of AKI?
internal/external obstruction of urine
What are examples of pre-renal causes of AKI?
- Hypovolemia
- Haemorrhage Diarrhoea - Renal artery stenosis
- Acei, ARBs - Hypotension:
- Sepsis
- Heart failure
- Burns
- Surgery
- NSAIDs
Why do NSAIDs cause hypotension?
decrease in prostaglandins which results in vasodilation
What are internal post-renal causes of AKI?
- Renal caliculi
2. Urethral stricture
What are external post-renal causes of AKI?
- Pelvic malignancy
2. BPH
What are the glomerular renal causes of AKI?
- Glomerulonephritis
2. Haemalytic Uraemic Syndrome (HUS)
What is HUS?
triad of microangipathic haemolytic anaemia, thrombocytopaenia and AKI- associated with shiga-toxin producing E.Coli infections- can precipitate AKI because glomeruli become clogged with platelets and damaged RBCs - children
What are the vascular renal causes of AKI?
vasculitis e.g. granulomatosis with polyangiitis (Wegners)
When is AKI more common?
elderly and co-morbidities eg diabetes
What are the tubular renal causes of AKI?
- Acute tubular necrosis !!
2. Multiple myeloma
What are causes of acute tubular necrosis?
- Ischaemic causes eg thromboembolism, nephrotoxic drugs, rhabdomyolysis
- Due to pre-renal AKI causes eg hypotension, sepsis
- Brown parts in urine
What are the interstitial disease renal causes of AKI?
- Acute interstitial nephritis
- immune-mediated tubulointerstitial injury
- due to drug hypersensitivity reaction
How does acute interstitial nephritis present?
- rash
- fever
- arthralgia
- eosinophiluria
What is the presentation of AKI?
- malaise
- anorexia
- vomiting
- pruritis
- drowsiness
- oliguria
- coma
- Cause specific
What is important to ask in AKI history?
- started nephrotic drugs
2. recent allergic reactions, burns or major surgery
What are the functions of the kidney?
- maintaing acid-base balance
- maintaing water balance
- electrolyte balance
- toxin removal
- blood pressure control
- making Erythropoeitin
- Vitamin D metabolism
What are complications of AKI?
- Metabolic acidosis
- Hyperkalaemia, hyperphosiamia
- Hyper or hypo volemia
- Ureamia: increase risk of encaphalopathy and pericarditis
- Hypertension
What are the investigations for AKI?
- Bloods: LFTs, FBC, U + Es bicarbonate, blood film
- Urinanalysis
- ECG
- CXR
- USS
- Renal biopsy
What is the management of renal causes of AKI?
Refer to specialist: likely biopsy
What is the management of pre-renal AKI?
manage volume depletion
What is the management of post-renal AKI?
Catheter, urological intervention
What else do you need to consider with renal management?
- A: acidosis ABG/VBG= monitor acidosis
- W: monitoring fluid balance to ensure no fluid overload
- E: potassium levels/ ECG= ensure no hyperkalaemia, Hyperkalaemic= sign on an ECG? Tented t-waves
- T: Urea
When would you need to consider renal replacement therapy?
- hyperkalaemia, pulmonary oedema are not being controlled by medical management
- severe metabolic acidosis, uraemic complications
What is the management of hyperkaelaemia?
- Normal saline
- calcium gluconate IV (10ml of 10%) - to prevent cardiac arrhythmias
- 50ml 50% dextrose with 5U actrapid insulin over 15 mins - to drive potassium into cells
- Then nebulised salbutamol
What is the management of metabolic acidosis?
IV sodium bicarbonate
What is the management of pulmonary oedema?
- Oxygen
- IV diamorphine: relives anxiety and breathlessness
- IV GTN
- Frusemide
What is the definition of chronic kidney disease (CKD)?
- Kidney damage (proteinuria/haematuria)
- OR GFR <60ml/min/1.73m2
- FOR 3 Months
What are the stages of CKD?
- risk increases with age
- severity with decreasing eGFR
What are the glomerular causes of CKD?
- Glomerulonephritis
- DIABETES
- Amyloidosis
- SLE
What are the vascular causes of CKD?
- HYPERTENSION
- Heart failure
- TTP
What are the tubular/interstitial causes of CKD?
- Interstitial nephritis
- pyelonephritis
- medication
What are the obstruction causes of CKD?
- Kidney stones
- BPH
- Multiple myeloma
What are the medication causes of CKD?
NSAIDs and some antibiotics
What are the congenital causes of CKD?
- PCKD
2. Alport syndrome
What is the presentation of chronic kidney disease?
- Pruritis
- Nausea and Vomiting
- Anorexia
- Oedema
- Polyuria (start) /oliguria (end)
- Shortness of breath (pulmonary oedema)
- Bruising
- Cause specific
- Can be asymptomatic as well and aki
What are the investigations for CKD?
- Bloods
- Urinalysis
- CXR
- Renal US
- Renal biopsy
What bloods do you do for CKD?
- U+ E important for eGFR
- glucose to check for underlying diabetes
- Ca, phosphate
- Autoantibodies
What is renal osterodystrophy?
kidneys unable to maintain levels of calcium and phosphate
What do you look for un urinalysis for CKD?
- granular casts (degenerated tubular cells seen in CKD)
- haematuria
- proteinuria
Why do you do a CXR for CKD?
may detect osteomalacia- sign of renal osteodystrophy which is a complication of CKD
What can an US show for CKD?
- kidney atrophy
- obstructive causes of CKD
- asymmetrical small consider renovascular disease
How do you investigate eGFR?
serum electrolytes, urea and creatinine
What is the definition of glomerulonephritis?
inflammation of the glomeruli leading to nephritic/nephrotic syndrome
What are the two main symptoms of glomerularnephritis?
- proteinuria
2. haematuria
What does IgA nephropathy cause?
nephritic syndrome
What are the main symptoms of nephritic syndrome?
- Haematuria (cococola coloured urine)
- Oedema
- Hypertension
- Oliguria
