Renal Flashcards
What 2 factors can you look at to diagnose AKI?
1) Urine output
2) Creatinine
How many AKI grades are there?
3
Give the creatinine criteria for each AKI grade
1) Rise of >26 umol/L or 1-1.9x baseline
2) Rise of 2.0-2.9x baseline creatine
3)
- > 3.0x baseline creatine or
- > 353.6 umol/L or
-initiation of renal replacement therapy or
- decrease of eGFR to < 35 mL/min
Give the urine output criteria for each AKI grade
1) <0.5 ml/kg/hr for 6 hours
2) <0.5 ml/kg/hr for 12 hours
3) <0.3 ml/kg/hr for >24h or anuria for 12h
What should you ALWAYS ask for when interpreting investigations?
Previous investigations to compare
What is the earliest clinical marker of a developing AKI?
Urine output
Why is creatinine a good marker of renal function?
As it is almost 100% filtered by kidney
What renal function changes are acceptable after starting an ACEi?
A rise in the creatinine and potassium may be expected after starting ACE inhibitors.
Acceptable changes are an increase in serum creatinine, up to 30%* from baseline and an increase in potassium up to 5.5 mmol/l*.
What rise in serum creatinine is acceptable after starting ACEi?
Up to 30% from baseline
What rise in serum potassium is acceptable after starting ACEi?
Up to 5.5 mmol/l
What is the most common group of causes of AKI?
Pre-renal e.g. 2ary to dehydration or sepsis
ECG signs of hyperkalaemia?
1) tall, tented T waves
2) flattened P waves
3) broad bizarre QRS
Emergency management of hyperkalaemia?
1) IV calcium gluconate 10%
2) Salbutamol 5mg nebulised
3) Insulin dextrose infusion
4) Dialysis/haemofiltration if not responding
How long should Abx be prescribed for in women >65?
3 days (also send a urine culture)
Next steps in suspected UTI if associated with visible or non-visible haematuria?
Send an MSU for all women with a suspected UTI if associated with visible or non-visible haematuria
Why are patients with nephrotic syndrome at an increased risk of VTE?
Due to loss of antithrombin III
What testicular volume indicates onset of puberty?
> 4ml
What is the treatment for acromegaly?
Ocreotide
How can the SAAG gradient be calculated?
Serum albumin - ascitic albumin = SAAG gradient
What does a high SAAG indicate (i.e. >11 g/L)?
Low levels of protein in ascitic fluid e.g. portal HTN, RHF
What cause of nephrotic syndrome is frequently associated with malignancy?
Membranous nephropathy
What is SAAG used to determine?
Whether ascites has been caused by portal HTN or not.
What is Budd Chiari syndrome?
Hepatic vein thrombosis
Can lead to portal HTN
How can rhabdomyolysis cause AKI?
Due to acute tubular necrosis –> myoglobin is nephrotoxic.
What condition typically presents with haemoptysis + AKI/proteinuria/haematuria?
Anti-GBM disease (Goodpasture’s)
What is the most likely outcome following the diagnosis of minimal change nephropathy in a 10-year-old male?
Full recovery but with later recurrent episode