Renal Flashcards
AKI stages - action on those bloods
Stage 1 - x1.5 baseline Creat —> Rpt + r/v her 72hrs (unwell rpt 24hrs)
Stage 2 = x2 baseline —> 24hrs (unwell - r/v now)
Stage 3 = >x3 baseline —> Admission
Drugs caution in AKI
DAMN _ 2 more
Dieurtics, ACE, Metforin, NSAIDs
Sulphylurea accumulate causing hypo
Trimeth accumulate causing hyperkalaemia
Creat rules increase in ACE
15-30% - rpt in 1 - 2 weeks
>30% - re-check in 5 days, stil high = STOP - d/w HF team if needed
Spironolactone rules in starting with blood
U+Es prior, 1 week after then 3 monthly once stable
Stop if K >6
Only start again for HF if K <5.5
Rules for Apixban and nitro in low eggar
Apixban 2.5mg BD Egerton <30
Nitro CI if egr <45 due to peripheral neuropathy risk
how often should an pt with egfr 48 + ACR 38 be monitored
CKD 3b + A 3 => 2/year
when should CKD be referred
An estimated glomerular filtration rate (eGFR) of less than 30
Accelerated progression of chronic kidney disease (CKD), defined as:
A sustained decrease in eGFR of 25% or more within 12 months and a change in CKD category.
A sustained decrease in eGFR of 15 mL/min/1.73 m2 or more within 12 months.
A urinary albumin:creatinine ratio (ACR) of 70 mg/mmol or more, unless proteinuria is known to be associated with diabetes mellitus and is managed appropriately.
A urinary ACR of 30 mg/mmol or more together with persistent haematuria, after exclusion of a urinary tract infection (UTI)
Hypertension that remains uncontrolled despite the use of at least four antihypertensive drugs at therapeutic doses.
A suspected or confirmed rare or genetic cause of CKD, such as polycystic kidney disease.
Suspected renal artery stenosis.
- This should be suspected if there is a greater than 25% reduction in eGFR within 3 months of starting (or increasing the dose of) a renin-angiotensin system antagonist, refractory hypertension, pulmonary oedema, and/or a renal artery bruit.
