Renal

Question 1

AKI

Answer 1

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Signs
Anasarca - nephrotic syndrome
Pain
Anurea
Haematourea - nephritic: hypertension, protein urea, haemorurea

AKI, CKI, Nephrotic, neohritic, isolated urinatory

Function
Excretion
Fluid retention
Hormones - ADH, Renin, erythropoietin, calciferol

Look at staging

Is a syndrome therefore needs qualification- RIFLE, AKIN, KDIGO
Serum creatinine - Nb baseline, do they have CKD. Drugs and muscle mass
Anuric or oliguria (30ml/h)

In CDK endocrine function goes off
Anaemia, normocytic
Renoostiodystrophy
Small and shrivelled kidneys (except for diabetes)

Causes
Pre renal - blood flow (should be 1.2l therefore 600ml per min, 125ml filtered_
- Dehydration - postural drop 5mins laying, stand and measure at 1min and 3min. Nb drop in BP and increase in HR
- Sepsis
- Hypovolaemic shock
- Bilateral renal stenosis
- Abdominal compartment syndrome

Preserved renal function, reversible until it becomes ATN

Renal
- Vessels
- Glomerular nephritis
- Tubulo interstitial
Affected by:
- Drugs
- Diuretics
- Contrast
- Gentomycin and vancomycin
- NSAID
- Metformin

Post renal

• Blockage of urinary tract
• Stones
• Cancer
• Gynae
• Prostate

Leads to hydronephrosis and pelivicalyceal dilatation

Tests
Urine dip - protein or blood
US - looking for post renal disease

Management
Fluids
Abx for sepsis
Stop nephrotoxic drugs
Investigate cause
Control BP and sugar

CKD - with hypertension and diabetes
Try to preempt
Complications - needs to be haemofiltered
Hyperkalaemia
Metabolic acidosis
Pulmonary oedema
Uraemic syndrome