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Phase 4 > Renal > Flashcards

Renal Flashcards

1
Q

What is Stage 1 AKI

A

rise in serum creatinine > 26.5 micromol/L within 48hrs or 1.5 - 1.9 x the baseline

urine output less than 0.5ml/kg/hr for 6 - 12hrs

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2
Q

What is Stage 2 AKI

A

rise in serum creatinine 2.0 - 2.9 x the baseline

urine output less than 0.5ml/kg/hr for more than 12hrs

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3
Q

What is Stage 3 AKI

A

rise in serum creatinine > 353.6 micromol/L or 3 x the baseline

On RRT

urine output less than 0.3ml/kg/hr for more than 24hrs or anuric for more than 12

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4
Q

what is the most common type of AKI

A

pre-renal

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5
Q

What can cause decreased renal perfusion

A

reduced circulating volume: hypovolaemia

reduced cardiac output: cardiac failure

systemic vasodilation: sepsis

arteriolar changes: secondary to ACEi or NSAIDs

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6
Q

what can prolonged renal ischaemia cause

A

acute tubular necrosis

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7
Q

what is the most common intrinsic cause of AKI

A

ATN

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8
Q

what are the intrinsic causes of aki

A

vascular:
- large vessels e.g. atherosclerotic, thromboembolic, renal artery stenosis;
- small vessel disease: vasculitides, thromboembolic disease, microangiopathic haemolytic anaemias (DIC), malignant hypertension

Glomerular: can cause nephritic/nephrotic syndrome; major cause of CKD

Tubulointerstitial: damage to renal parenchyma eventually leading to scarring and fibrosis

  • ATN
  • Acute interstitial nephritis secondary to medications e.g. PPI, NSAIDs, penicillins and infections
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9
Q

Percentage of AKI that are post-renal

A

10%

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10
Q

Causes of post renal AKI

A

urinary stones (urolithiasis)
malignancy
strictures
bladder neck obstruction (e.g. BPH)

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11
Q

Risk factors for developing AKI

10, list at least 5

A 
Age > 65 
history of AKI 
CKD
urological history 
cardiac failure 
DM 
Sepsis 
hypovolaemia 
Nephrotic drug use 
contrast agents
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12
Q

causes of acute tubular necrosis

A

ischaemic

nephrotoxic: medication (aminoglycosides, chemotherapies), contrast, myoglobin (i.e. rhabdomyolysis) and multiple myeloma

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13
Q

Presentation of pre-renal AKI

A 
reduced CRT
dry mucous membranes
reduced skin turgor
thirst
dizziness
reduced urine output
orthostatic hypotension

cardiac failure

  • ankle swelling
  • orthopnoea
  • paroxysmal nocturnal dyspnoea
  • dyspnoea
  • raised JVP
  • ascites
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14
Q

Investigations for AKI

A

Bedside: fluid status and balance, urine dipstick and microscopy, urine osmolality and electrolytes, ECG

Bloods: FBC, U+E, bone profile, VBG
- other bloods based on suspicion: creatinine kinase, vasculitis screen, clotting, blood film, complement, immunoglobulins, serum electrophoresis, virology

Imaging: USS, CXR, renal dopplers, magnetic resonance angiography

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15
Q

When should you discuss AKI with a specialist

A
  • Stage 3 AKI or in patients that might require specialist intervention (renal)
  • within 48hrs
  • Obstructive AKI: consider discussing with urology
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16
Q

management of AKI

A

Daily bloods

Monitor fluid status + manage fluid dysregulation (IVI or fluid restriction +/- diuretics)

Stop nephrotoxic drugs

Manage electrolyte imbalances (e.g. hyperkalaemia, hypocalcaemia, hyperphosphataemia)

17
Q

complications of AKI

A

Hyperkalaemia, fluid overload, metabolic acidosis, uraemia

- if these don’t improve with treatment it is an indication for urgent dialysis

18
Q

management of hyperkalaemia

A
  • 10 ml of 10% calcium gluconate
  • insulin/dextrose (10 units ACTRAPID in 100ml 20% dextrose) or beta agonists
  • calcium resonium to reduce potassium absorption; stop or adjust potassium sparing or containing medication
19
Q

management of metabolic acidosis in aki

A

sodium bicarbonate

dialysis

20
Q

what is CKD

A

presence of reduced GFR <60() or evidence of kidney damage for 3 or more months

21
Q

Classification of CKD

A 
G1 > 90 
G2 60 - 89 
G3a 45 - 59; G3b 30 - 44
G4 15 - 29
G5 <15

ACR

  • A1 < 3
  • A2 3 - 30
  • A3 > 30
22
Q

causes of CKD

A

DM
HTN
Glomerulopathies

Others: inherited kidney disorders, ischaemic nephropathy (e.g. vascular disease), obstructive uropathy, tubulointerstitial disease, medications

23
Q

signs and symptoms of CKD

A

symptoms

  • asymptomatic in early stages
  • anorexia + nausea
  • fatigue + weakness
  • muscle cramps
  • pruritus
  • dyspnoea
  • oedema

Signs

  • pallor
  • hypertension
  • fluid overload
  • skin pigmentation
  • excoriation marks
  • peripheral neuropathy
  • abdominal masses in PCKD
24
Q

what investigations are needed to diagnose CKD

A 
serum creatinine (helps to calculate eGFR)
urinary ACR
25
Q

investigations for CKD

A

Bedside: urine dipstick, microscopy, ACR, electrophoreses; ECG

Bloods: FBC, U+E, Bone profile, PTH, bicaronate, LFTs, lipid profile, autoimmune screen, myeloma screen

Imaging: renal USS, MRA, echocardiogram

Special: renal biopsy

Phase 4 (4 decks)

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