Renal Flashcards
Definition and detection of AKI
- rise in creatinine from baseline of >50% within 7 days -suspect of oligouria <0.5ml/kg/hr -check creatinine in all ill patients, especially if elderly, or confused -particularly if suspecting sepsis, HF, liver failure, hypotension, dehydration, diabetes -particularly if on nephrotoxic drugs
Nephrotoxic drugs
stop the DAMN drugs Diuretics ACEi and ARBs Metformin- not nephrotoxic, accumulates + causes lactic acidosis NSAIDs
Indications for dialysis in AKI
AEIOU Acidosis pH<7.1 Electrolytes e.g. refractory hyperkalaemia Intoxications e.g. salicylate, lithium Overloaded with fluid Uraemia symptoms e.g. encephalopathy
Emergency treatment of hyperkalaemia
Calcium glauconite to stabilise myocardium- 10ml of 10% slow IV Glucose and insulin IV- 10 units, in 50ml 50% glucose over 15 minutes Salbutamol
Causes of CKD
HIDDEN hypertension Infection e.g. ureteric reflux in children Diabetes Drugs e.g. analgesic nephropathy, NSAIDs, lithium Exotics e.g. SLE Nephritis, Glomerulonephritis
Indications for dialysis in CKD
Progressive decline in renal function <15ml/min Symptomatic uraemia despite conservative treatment Volume overload despite fluid restriction and Diuretics Other- pericarditis, Bone Disease, hyperkalaemia despite treatment
What is CAPD?
Tenckhoff catheter into abdomen Less expensive than haemodialysis More convenient as low tech- holidays Relatively easy to teach May have to stop due to peritonitis Fibrosis may reduce permeability 3 litres of fluid, 4 times a day with 30min exchanges Can cause diaphragm splinting, can’t use in COPD
What is removed in CAPD?
Urea, creatinine, potassium and phosphate pass along their concentration gradient- isotonic fluid Water is removed down an osmotic gradient, by including some bags of hypertonic fluid with a high glucose and polymer gradient
Peritoneal dialysis peritonitis
Cloudy effluent- urgent MC&S and culture from ‘first cloudy bag’ Abdominal pain +/- fever Exit site infection (take swab) If I’ll, take blood cultures Gram +ve staph or strep- intraperitoneal vancomycin Gram -ve or pseudomonas- IV ciprofloxacin Uncertain- use both
Questions to ask in CKD?
What are your energy levels like? Do you get breathless? Do you suffer from itching? (Hyperphosphataemia/ hyperuracaemia) Do you have joint pain/ gout? Do you get numb or tingling feet?
Three causes of fatigue in CKD
Anaemia- normochromic normocytic Anaemia of chronic disease Solute retention- many retained solutes are cerebral depressants Psychosocial- loss of employment, feeling trapped by chronic disease
Three causes of breathlessness in CKD
Anaemia, fluid overload, heart failure (CAD and hypertension are common)
Peripheral neuropathy in CKD
Retention of beta-2-microglobulin leading to amyloidosis of peripheral nerves Underlying diabetes is a common cause of CKD and causes neuropathy
Features of CKD
BIG BEAN Breathless Itching Gout Bone pain Energy levels low Ankle swelling/ anaemia Neuropathy
4 features of renal bone disease
Osteoporosis
hyperparathyroidism
osteomalacia
osteosclerosis
Treatment of nephrotic syndrome
Oedema- Diuretics and salt retention
minimal change Glomerulonephritis- steroids +/- cyclophosphamide
ACEi reduces protein excretion- lowers glomerular filtration pressure
anticoagulation
statins
CKD stages
CKD stages
