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MACHS > Renal > Flashcards

Renal Flashcards

1
Q

Reference acute kidney injury

A

Kdigo 2012

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2
Q

Whats normal serum creatinine levels?

A

0.7-1.3mg/dl

Kdigo 2012

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3
Q

How to detect acute kidney injury?

A
  1. Serum Creatinine raise - of 26micromol/litre or more in 48 hrs
  2. 50% or greater rise serum creatinine in past 7 days - there’s an algorithm for early identification endorsed by NHS england
  3. fall urine less than 0.5ml/kg/hr in 6 hours in adults and 8 hours children
  4. 25% or greater fall eGFR children in past 7 days

NICE 2019 - detect, prevent, manage AKI

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4
Q

Symptoms to identify acute kidney injury

A
  1. Fall in eGFR
    2.. rise in serum creatinine
  2. reduced urine output
  3. reduced BP - as normally renin would maintain
  4. oedema
  5. confusion
  6. metabolic acidosis
  7. hyperkalemia
  8. electrolyte imbalance
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5
Q

What is haemolytic uraemia syndrome?

A

Leading cause of AKI
1. Red blood cells breakdown so there’s high urea and waste in blood
2. notify public health as caused by e.coli
3. diarrhoea - bloody and vomiting
4. reduced neuro

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6
Q

Priorities for patient with haemolytic uraemia syndrome

A
  1. stool sample - e.coil
  2. blood transfusion and platelet transfusion
  3. fluid management - 500ml or 10ml/kg
  4. PD catheter and start PD
  5. isolate use PPE and hand washing
  6. parent and family testing
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7
Q

Normal eGFR?

A

works out kidney function rate

normal more than 90mls/minute

Stage one AKI starts at anything less than 90ml/min

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8
Q

How is eGFR normally regulated?

A

auto regulation

  1. prostaglandin - vasodilator to reduce blood in
  2. angiotensin - vasoconstrict to reduce blood out
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9
Q

Reference pathophysiology adult

A

Peate et al. 2021

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10
Q

Whats the function of the renal system?

A

Acid base balance - secretes hydrogen and reabsorbs bicarbonate = metabolic acidosis
Water levels - anti-diuretic hormone
Electrolyte balanc e- sodium, potassium and calcium
Toxin removal - urea and creatinine
Blood pressure - using renin hormone
Erythropoietin’s - stimulate RBC production
D - vitamin

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11
Q

Guidelines for acute kidney injury>

A

NICE 2019 - acute kidney injury: prevention, detection and management

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12
Q

Whats the pathophysiology of acute kidney injury?

A

reduced cardiac output means there’s not enough blood so kidney function cessation

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13
Q

Priorities to treat acute kidney injury?

A
  1. monitor
    - PEWS (NHSE 2023)
    - NEWS2 (RCP, 2017)
    - ECG - potassium causes arrhythmia with peaked T waves and small P waves.
    - weight (twice daily)
    - Urine output
  2. Medication
    - Not routine - if fluid overload or oedema - Loop Diuretics - stimate Urination and inhibit water reabsorpation - warning can increase potassium, calcium and sodium levels
    - Insulin
    - Stop NSAIDS as nephrtoxic
    - ACE inhibitors and angiotensin blockers (reduce filtration, increase function, inhibit potassium excretion)
    - refer for renal replacement therapy and nephrologist
  3. IV fluid maintainance - hartmanns - no potassium
  4. Source control do urinalysis if blood or nitrate - infection - antibiotics or proteins show an inflammatory response

THINK KIDNEY NHSE, 2016
NICE 2019

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14
Q

Whats normal hyperkalaemia>

A

3.5-5.0

NICE 2013- prevent, detect and manage AKI

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15
Q

What is hyperkalaemia>

A

increased potassium

caused by renal disease, diabetes, trauma, chemotherapy

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16
Q

Symptoms hyperkalaemia

A
  1. chest pain
  2. heart arrhymias - ECG - peak T waves and small P waves
  3. palpating
  4. muscle weakness and numbness
17
Q

Priorities of hyperkalaemia

A
  1. IV inject insulin - 5-10units to reduce sodium and potasssium
  2. salbutamol - IV or nebuliser to stabilise potassium levels
  3. diuretics to remove potassium
  4. stop any potassium medication

NICE BNF - 2024

18
Q

Tests/ Investigations causes acute kidney injury

A
  1. urinalysis - blood, protein, leukocytes, nitrites and glucose - treat cause eg. infection
  2. Ultrasound - when infected and obstructed kidneys suspected - perform within 6 hours of assessment - or no known cause

NICE 2019 - Prevent, detect, manage AKI

MACHS (6 decks)

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