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2a RRS > renal > Flashcards

renal Flashcards

1
Q

Treatment of Hyperkalemia

A

IV insulin and Glucose
since insulin stimulates uptake of Glucose
drives K+ IN

dialysis or haem filter

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2
Q

how to treat pul oedeama

A

diuretics - furosemide

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3
Q

what are CFs of AKI

A 
oliguria/anuria
pruritis
uraemia - confusion
HTN
fluid overload - oedema
signs of dehrydartion /urin retention
anaemia and pulm oedema secondary to vol overload = breathless
arrythmias (as high K+)
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4
Q

RFs forAKI

A 
diabetes
sepsis
low fluid intake/ high fluid loss
heart failure
CKD
liver disease
NSAIDs and ACEi
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5
Q

how to dignose AKI in terms of creatine etc

A

rapid change in urea and creatinine
increase in creatinine over 28umol/L (48hrs)
increase in creatine over 50% of baseline (7days)
urine output less than 0.5 ml/kg/hr >6 consec hours
(ONE OF THESE 3)

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6
Q

Prevention of AKI

A

monitoring drugs they are taking, temporarily stopping them if they have D and v
ensure patients in hospital are well hydrated use fluid volume charts
Med review if D and V

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7
Q

complications of AKI n how treat each

A

Hyperkalemia (insulin or glucose=drives K+ IN cell
calcium gluconate = cardio protective - calcium is inverse relationship w K+)
edema - diuretics - furosemide (loop diuretic)
uremia
acidosis - IV Na Bicarb (dont use in vol overload = pulm oedema)

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8
Q

What is creatinine and why is it used in Dx

A

its a muscle breakdown product that is filtered freely in the kidney and not reabsorbed so gives indication of kidney filtration levels. elevated serum creatinine suggest reduced filtration

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9
Q

what does Acute kidney injury mean

A

Spectrum of kidney disease ranging from mild improvement to full kidney failure requiring RRT

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10
Q

causes of AKI

A

commonest are ischemia, sepsis, nephrotoxins
Pre renal - commonest cause (70%)
renal-
Post renal causes- least common

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11
Q

3 diff types of aki and basic reason for each

A

pre renal - hypoperfusion
renal - struct damage
post renal - obstruction

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12
Q

ECG changes of hyperkalemia

A

tall tented T wave
absent P wave
increased PR interval
wide QRS

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13
Q

what are the complications of uremia in AKI

A

confusion , coma

neuropathy,

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14
Q

Indications to refer AKI to nephrologist

A

Hyperkalemia

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15
Q

WHat are indications for dialysis in AKI

A

Fluid overload signs and symptoms, JVP, Oedema , nocturnal Dysnpnoea
or Anuria
Hyperkalemia
metabolic acidosis
Uraemic complications like encephalopathy
drug overdose

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16
Q

Managment of AKI

pre renal

A

if sepsis = ABX
if not
correct fluid / electrolyte imbalance w fluid resus

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17
Q

management of aki

renal

A

may need dialysis or refered to nephrologist

treat underlying Cx

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18
Q

Managment of AKI

post renal

A

catherise

monitor urine output

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19
Q

management of AKI general

A

stop NSAIDs and ACEi and genamicin ABX
(= NEPHROTOXIC drugs)
treat underlying cause

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20
Q

Dx what do u always ask about in AKI

A

DRUG CHANGES

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21
Q

causes of post renal AKI

A

outflow obstruction
= stones malig and clots
increase p decreases p gradient so GFR decreases

22
Q

which malig in post renal AKI most likely cause of outflow obstruct

A

bladder ureter and prostate

23
Q

causes of renal AKI

A 
within kidney  structual damage
Cx= acute tubular necrosis
SLE 
NSAIDs
sustained hypoperfusion - prerenal AKI
vasular - ischeamic, high BP
glomerulonephritis
24
Q

causes of pre renal AKI

A 
HYPOPERFUSION
so hypovolaemic shock
renal artery stenoisis
sepsis
dehydration - NAUSEA N VOM
Burns
haemmorage
NSAIDs and ACEi
25
Q

how does NSAIDs and ACEi cause decrease in GFR

A

postaglandins = afferent dilation
angiontensin 2 = efferect constriction === both increase GFR
HENCE
if blocker GFR deceaseas

26
Q

Dx of AKI

A 
ECG - hyperkalaemia
rapid rise in urea and creatinine (see diff card)
ask about drug changes
bladder outflow? palpate
bloods - fbc = anaemia 
urine blood and culture - excl infection 
CXR - pul oedema
US - size = small in CKD
27
Q

what is CKD

A

impsaired renal function for over 6 months based on abnormal structure or function or GFR<60ml

28
Q

what is chronic kidney disease, time to become chronic

A

Renal impairment for more than 3 Months

29
Q

how is chronic kidney disease staged and what symptoms are found at each stage

A

EGFR
stage 1 > 90 just has risk factors
stage 2 = 60-90 proteinuria
stage 3 = 30-59 still asymptomatic, N and V
stage 4 = 15-30 this is when symptoms usually start to show
end stage renal failure <15 - needs RRT at this stage

30
Q

causes of CKD

A 
primary glomerulonephritis
VITAMIN C
V- vascular - HTN, renal artery stenosis, vasculitis
Infective -polyneophritis
Trauma
Autoimmune - SLE, DM
Metabolic
Idiopathic
Neoplastic

Congen - polycystic kidney

31
Q

CFs of CKD

A 
asmpt to moderate
anorexia
N&amp;V
fatigue
periph oedema
LUTS
anaemia (less EPO)
prutitis
easy bruising 
polyuria
32
Q

why would CKD cause anaemia?

A

less EPO

33
Q

Rf for CKD

A

HTN
DM
atherosclerotic renal vasc disease
women african

34
Q

pathophsyiology behind CKD

A

HYPERFILTRATION
HTN - BV walls thicken = less oxygen nd blood = ischaemic injury to glomerulus
macrophages and foam cells secrete growth factors - TNF-beta1 - mesengial cells to mesangioblasts
secrete extra cell matrix == GLOMERULOSCLEROSIS
cant filter blood

35
Q

how does diabetes cause increase risk of CKD

A

XS glucose sticks to proteins in efferent arteriole = stiff and narrow (HALINE SCLEROSIS )
so increased p within glomerulosis = HYPER FILTRATION

36
Q

complications of CKD

A 
FLASH BACK
Fluid overload 
(l)
Acidosis
Sympotoms of ureamia (CNS encephalopathy - asterix confusion etc)
HTN

Bone disease - phosphate retention = hypOcalcaemia. less vit D activaation = less ca absorbed
Anaemia (less EPO) = pallor lethargy
CVS dis - pericaditis, pericardial rub, cardiomegaly
K increase (hyperkalcemia = AF)

37
Q

Dx of CKD

A 
ECG - hyperkalaemia 
urinalysis - haematuria proteinuria 
bloods - INCREASED urrea and creatinine
USS - SMALL KIDNEYS*****
eGFR - LOW
low calcium high PTH high phosphate 
high renin
creatinine clearance test = estomates eGFR
38
Q 
Mx of CKD
#conservative
A

treat reversible causes - stop smoking, excersie diet etc
stop nephrotoxic drugs (NSAIDs ACEi)
treat complic - bone ; vit D , anaemia etc
maintain optimal bp -
Diet, avoid high phosphate food, Potassium restrictions

39
Q

Mx of CKD

stage 1 to 4

A

Main cause of death is CVD

so ACEi or ARB plus statins plus diuretics plus CCB if needs be

40
Q

Mx of CKD end stage

A

transplant/dialysis = RNEAL REPLACEMENT THERAPY

dialysis - peritoneal or haemodialysis

41
Q

what is peritoneal dialysis

A

metabolic waste diffuses dwon gradient into dialysis fluid via peritoneal capillaries

42
Q

what is haemoialysis

A

hospoital or home -

Hypotension, nausea infection risk

43
Q

whos is screened for Chronic kidney disease

A 
screen at risk patients 
Diabetes 
Hypertension 
CVD 
BPH 
Recurrent UTI 
Family history of ESRD 
Congenital kidney disease like PCKD
44
Q

how is screening for Chronic kidney disease done

A

Albumin creatinine ratio
urinalysis
serum creatinine

45
Q

acute renal failure vs chronic

size of kidneys

A 
acute = normal
chronic = small
46
Q

acute renal failure vs chronic

diabetes?

A

not in acute

assos with chronic

47
Q

acute renal failure vs chronic

anaemia assos?

A

acute NO

chronic YES normocytic normochromic

48
Q

acute renal failure vs chronic

which has high BP

A

chronic

=low in acute

49
Q

acute renal failure vs chronic

time frames

A

acute - rapid change in urea/creatine

chronic - gradual sympotom onset

50
Q

acute renal failure vs chronic

oliguria?

A

acute - yes

chronic - only later stage

51
Q

acute renal failure vs chronic

cns involvment?

A 
Acute = none
chronic = late stage as urea increases
52
Q

acute renal failure vs chronic

sympotms description

A

acute - shock like

chronic - like serious extensive disease

2a RRS (26 decks)

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