Renal

Question 1

What are the stages of AKI

Answer 1

Stage 1 - Serum creatinine >1.5x baseline OR urine output <0.5 <12hrs

Stage 2 - Serum creatinine >2x baseline OR UO <0.5 >12hrs

Stage 3 - Serum creatinine >3x baseline OR UO <0.3 >24hrs or anuric >12hrs

Question 2

What are the stages of CKD

Answer 2

Stage 1 - GFR normal (90) or increased (>90) but with evidence of kidney damage

Stage 2 - GFR <90

Stage 3a - GFR <60

Stage 3b - GFR <45

Stage 4 - GFR <30

Stage 5 - GFR <15

Question 3

What are the indications for dialysis

Answer 3

ACUTE DIALYSIS
A - acidosis (severe and not responding)

E - electrolyte abnormalities (hyperkalaemia severe and unresponsive)

I - intoxication (overdose of certain medications)

O - oedema (severe and unresponsive pulmonary oedema

U - uraemia (symptoms eg. seizures and reduced consciousness)

G - GFR<15
LONG-TERM DIALYSIS
- end stage renal failure
(CKD stage 5)

Question 4

What is the treatment of HYPERkalemia

Question 5

What is the treatment of HYPOkalemia

Question 6

Causes of AKI

Answer 6

DUE TO BEING UNABLE TO FILTER THE BLOOD ADEQUATELY

Pre-renal (inadequate blood supply to the kidney)
- dehydration
- hypotension (and shock)
- heart failure

Intra-renal (intrinsic disease)
- glomerularnephritis
- interstitial nephritis
- acute tubular necrosis

Post-renal (obstruction in the outflow of urine –> back up into the kidney and reduce function)
- kidney stones
- masses in abdomen or pelvis
- ureter strictures
- enlarged prostate/prostate cancer

Question 7

Nephrotoxic drugs

Answer 7

NSAIDs

Medications that normally REDUCE THE FILTRATION PRESSURE
- Antihypertensives (ACE inhibitors)

Question 8

what does protein and blood in the urine show?

Answer 8

• infection
• acute nephtiris

BLOOD - exclude bladder cancer

Question 9

what do leukocytes and nitrates in the urine show?

Answer 9

infection

Question 10

what does glucose in the urine show?

Answer 10

diabeties

Question 11

when to use USS in AKI?

Answer 11

to look for obstruction - not needed if an alternative cause is found

Question 12

How to treat AKI?

Answer 12

1) fluid rehydration with IV fluids (in pre-renal AKI)

2) Stop nephrotoxic medications

3) Relieve obstruction (in post-renal AKI) - eg. insertion of a catheter if have an enlarged prostate

Question 13

What are the complications of AKI?

Answer 13

hyperkalemia
fluid overload, heart faliure and pulmonary odema

metabolic acidosis
ureamia –> enchephalopathy or pericarditis

Question 14

What are the complications of AKI?

Answer 14

hyperkalemia
fluid overload, heart faliure and pulmonary odema

metabolic acidosis
ureamia –> enchephalopathy or pericarditis

Question 15

Causes of CKD

Answer 15

Diabetes
hypertension
age-related decline
glomerulonephritis
polycystic kidney disease
medications (NSAIDs, PPIs, lithium)

Question 16

risk factors for CKD

Answer 16

older age
hypertension
diabetes
smoking
medications

Question 17

signs of CKD

Answer 17

itching
loss of appetite
nausea
oedema
muscle cramps
peripheral neuropathy
pallor
hypertension

Question 18

complications of CKD

Answer 18

1) renal bone disease

Question 19

what is renal bone disease and what causes it

Answer 19

osteosclerosis (hardening), osteoporosis (brittling) and osteomalacia (softening)

Due to increase in phosphate (reduced excretion) low vit D (due to lack of kidney being able to metabolise it into its active form)

Low vit D = low calcium absorption in the gut