Renal Flashcards
drugs which need to be reduced or stopped in people with CKD
Antidiabetic: - metformin - glibenclamide - glimepiride Antivirals: - famiciclovir - valaciclovir Antiarrhythmics: - digoxin - sotalol Other: - gabapentin - colchicine - lithium
what is acute tubular necrosis (ATN)
diffuse tubular cell damage due to either:
- ischaemic kidney injury (surg/trauma)
- drugs
- sepsis
- pregnancy
how many people with ARF will have ATN
75%
causes of ARF
pre-renal (inadequate perfusion)
renal (glomerular/tubular/interstitial)
post-renal (obstruction)
Lab findings with ARF
hyperkalaemia metabolic acidosis (high anion gap) hyperphosphataemia hypocalcaemia anaemia (sometimes) abnormal urinalysis and urine microscopy
prerenal causes of ARF
hypovolaemia
systolic heart failure
vascular pooling (sepsis, anaphylaxis)
renal causes of ARF
ATN
toxins: abx (aminoglycosides, penicillins, sulphonamides), NSAIDs, heavy metals
rhabdomyolysis, haemolysis
radiology contrast
pregnancy (uterine haemorrhage, eclampsia)
intrarenal vascular diseases, glomerulonephritis, interstitial nephritis
post renal causes of ARF
outflow obstruction (prostate, bladder, tumours, stones)
phases of ARF
Incipient phase: low urine output, reversible, low urine Na
oliguric phase: low urine output, established ATN, high urine Na
diuretic phase: high urine output, damaged tubules unable to retain Na or H2O
how do you manage the incipient phase of ARF
try to reverse cause
IV rehydration with N Saline
Frusemide
how do you manage the established phase of ARF (oliguric phase)
IV replacement fluids (insensible + output)
monitor and tx of electrolytes
try to treat underlying cause/optimise
how do you manage the diuretic phase of ARF
strict fluid balance
weigh pt and monitor electrolytes
adjust replacement IV fluids every few hours.
often N saline + KCl due to K+ loss.
criteria for CKD
- kidney damage for 3months or more; pathological abnormalities or markers of kidney damage (composition of blood or urine)
and/or - GFR <60mL/min/1.73m2 for 3 months or more.
markers of kidney function that are not GFR
proteinuria (24hr protein/albumin, or a protein/creatinine ratio)
haematuria (glomerular = casts)
what is an infection which can cause CKD
malaria from mosquitos
