Renal Flashcards
What medications need to be stopped in AKI as they may worsen renal function?
- NSAIDs
- Aminoglycosides - gentamycin , tobramycin
- ACE-i
- ARB
- Diuretics
What meds need to be stopped in AKI as they can cause toxicity?
- Metformin
- Lithium
- Digoxin
What is the thresholds for the different levels of hyperkalaemia?
Mild: 5.5 - 5.9 mmol/L
Moderate: 6.0 - 6.4 mmol/L
Severe: ≥ 6.5 mmol/L
What is the criteria for the diagnosis of AKI?
- A rise in serum creatinine of 26 micromol/litre or greater within 48 hours
- A 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days
- A fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults and more than
What is the staging criteria for Stage 1 AKI?
- Increase in creatinine to 1.5-1.9 times baseline, or
- Increase in creatinine by ≥26.5 µmol/L, or
- Reduction in urine output to <0.5 mL/kg/hour for ≥ 6 hours
What is the staging criteria for Stage 2 AKI?
- Increase in creatinine to 2.0 -2.9 times baseline, or
- Reduction in urine output to <0.5 mL/kg/hour for ≥ 12 hours
What is the staging criteria for Stage 3 AKI?
- Increase in creatinine to ≥ 3.0 times baseline, or
- Increase in creatinine to ≥353.6 µmol/L or
- Reduction in urine output to <0.3 mL/kg/hour for ≥24 hours, or
- The initiation of kidney replacement therapy, or,
- In patients <18 years, decrease in eGFR to <35 mL/min/1.73 m2
what are the causes of normal anion gap metabolic acidosis?
- gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
- renal tubular acidosis
- drugs: e.g. acetazolamide
- ammonium chloride injection
- Addison’s disease
what are the drugs that cause acute tubular necrosis?
Please RSVP:” Rifampin, Sulfa drugs and the V (5) Ps (Proton pump inhibitors, Pain killers (NSAIDs), “Pee pills” (diuretics), Penicillins, and Phenytoin) are the drugs that cause interstitial nephritis.
what are the features of acute intersistial nephritis?
- fever, rash and arthralgia
- eosinophilia
- mild renal impairment
- hypertnsion
what are the investigation findings of acute interstitial nephritis?
- sterile pyuria
- white cell casts
how is the diagnosis of amyloidosis made?
- Congo red staining: apple - green birefrignence
serum amyloid precursor (SAP) scan
how is diabetic nephropathy screened for?
all patients should be screened annually using urinary albumin:creatinine ratio (ACR)
Do a spot test - of test abnormal - then first pass morning sample
why do CKD patients have bone pain and high phosphate?
As phosphate is renally excreted, if there is impaired renal function - phosphate will build up, ‘dragging’ the calcium out of the bones resulting in osteomalacia
what are the possible causes of transplant failure hours after the op?
Hyperacute rejection - due to pre-existing antibodies against ABO or HLA antigens
No tx is possible - graft must be removed
