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T year LOBs medicine > RENAL AKI > Flashcards

RENAL AKI Flashcards

1
Q

what are symptoms of uraemia?

A
  • nausea
  • vomiting
  • fatigue
  • weight loss
  • pruritus
  • mental changes
  • fits
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2
Q

what Pre-renal conditions cause AKI?

A

Hypovoeliama: can be dehydration or haemorrhage

hypotension: Cirrhosis or septic shock

Low CO: cardiac shock or heart failre

Renal artery stenosis

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3
Q

What renal conditions cause AKI?

A

Glomerulonephritis
Systemic disease
acute tubular necrosis
interstitial necrosis

nephrotoxicity due to drugs

Contrast

Rhabdomyolysis

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4
Q

What drugs are nephron-toxic?

A 
ACE inhibitors
metformin
NSAIDS
Diuretics
Statins
Vancomycin/ gentamycin
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5
Q

what are post renal causes of AKI?

A

Renal calculi
BPH
Tumour

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6
Q

what metabolic changes are seen in renal injury?

A 
Raised creatinine
Raised Urea
A rise in urine osmolality 
Hyperkalaemia
metabolic acidosis
hyponatraemia 
Anaemia (less EPO)
Low Vit D
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7
Q

what investigations can be done in AKI?

A
  • insert a urethral catheter to monitor fluid balance
  • urinanalysis
  • U and Es
    FBC
    ultrasound
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8
Q

what is the management of AKI?

A
  • Manage hyperkalaemia
  • Diuretics for water overload
  • antibiotics for any infection
  • Stop any nephrotoxic drugs
  • Haemodialysis or Haemofiltration
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9
Q

What is target Hb in acute renal failure?

A

10.5-12

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10
Q

how do you manage anaemia in AKI?

A
  • check it’s not iron/B12 deficiency
  • Ferritin <200 give IV iron
  • Give EPO
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11
Q

How do you assess if the patient is volume depleted?

A
  • postural hypotension
  • decreased JVP
  • increased Pulse
  • skin turgor decreased
  • Dry mucous membranes
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12
Q

what are indications for acute dialysis?

A 
Persistant hyperkalaemia
refractory pulmonary oedema
symptomatic uraemia
Severe metabolic acidosis
Poisoning
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13
Q

what ECG changes are seen in hyperkalaemia?

A
  • Peaked T waves
  • flattened P waves
  • increased PR interval
  • widened QRS
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14
Q

what is the management of hyperkalaemia?

A

10ml 10% calcium gluconate

50ml 50% glucose and insulin

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15
Q

what are symptoms of chronic kidney disease?

A
  • confusion and fits if there is severe uraemia
  • hypertension
  • heartfailure
  • nocturia, polyuria, salt and water retention
  • oedema
  • polyneuropathy
  • amenorrhoea
  • anorexia
  • weight loss
  • vomiting
  • diarrhoea
  • bruising
  • pigmentation
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16
Q

why are people with chronic renal failure at risk of bone disorders?

A
  • The kidneys carry out 1 hydroxylation for vit D and therefore calcium absorption
    Low calcium will stimulate PTH causing calcium release from bone
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17
Q

why do people with chronic renal disease get hypernatraemia?

A

Low GFR means low flow through juxtaglomerular apparatus. RAAS is stimulated

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18
Q

what are causes of CKD due to inherited and congenital conditions?

A
  • polycystic kidney disease
  • tuberous sclerosis
  • cystinosis
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19
Q

what is the staging for CKD?

A 
1- GFR >90. evidence of kidney damage
2- GFR 60-89
3a- GFR 45-59
3b- GFR 30-44
4. 15-29
5. >15
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20
Q

what are common causes of chronic kidney disease?

A

Diabetes Melitus

hypertension

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21
Q

what are possible complications of chronic kidney disease?

A 
Cardiovascular disease
Renal osteodystrophy
Fluid (oedema)
HTN
Electrolyte disturbances
Anaemia
Leg restlessness
Sensory neuropathy
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22
Q

what are the symptoms of autosomal dominant polycystic kidney disease?

A
  • loin pain
  • haematuria
  • abdominal discomfort
  • berry aneurysms
  • uraemia
  • renal calculi
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23
Q

what is stage 1 hypertension?

A

140/90 or higher in clinic.

ABPM average 135/85

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24
Q

what is stage 2 hypertension?

A

clinical blood pressure 160/100 or higher

ABPM average 150/95 or higher

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25
Q

what is severe hypertension?

A

180/110 or higher

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26
Q

what is the blood pressure target for people under 80?

A

140/90

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27
Q

what is the blood pressure target for people over 80?

A

150/90

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28
Q

what is the management of hypertension in people under 55 years?

A
  1. ACE inhibitor or Low cost ARB
  2. Ace inhibitor + Calcium channel blocker
  3. Ace inhibitor+ calcium channel blocker + thiazide like diuretic
  4. Ace inhibitor+calcium channel blocker + thiazide diuretic + alpha/beta blocker
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29
Q

what is the management of hypertension in someone over 55 or block African/ caribean?

A
  1. Calcium channel blocker OR thiazide like diuretic
  2. Ace inhibitor + calcium channel blocker OR thiazide diuretic
  3. Calcium channel blocker + ACE inhibitor + thiazide like diuretic.
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30
Q

what are some common causes of hypertension?

A
  • renal disease
  • vascular disease
  • conns syndrome
  • cushings syndrome
  • phaechromocytoma
  • pre eclampsia
  • primary
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31
Q

what are some effects of hypertension?

A
  • atherosclerosis
  • aneurysm
  • aortic dissection
  • haematuria
  • pulmonary oedema
  • MI
    LVH
  • vascular dementia
  • haemorrhages
  • exudates
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32
Q

what are some symptoms of hypertension?

A
  • headache
  • visual changes
  • fatigue
  • confusion
  • irregular heartbeat
  • haematuria
  • nose bleed
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33
Q

what are signs of alkalosis?

A
  • confusion
  • hand tremor
  • light headed
  • muscle twitches
  • nausea
  • numbness
34
Q

what is a ddx for metabolic acidosis?

A

severe sepsis, shock, DKA, pancreatic fistula, lactic acidosis, ethanol/aspirin poisoning, renal failure, renal tubular acidosis

35
Q

what are ddx of metabolic alkalosis?

A

excessive thiazide use, vomiting,over use of alkaline antacids and hypokalaemia

36
Q

what are ddx for respiratory acidosis?

A

airway obstruction, COPD, aspiration, strangulation, respiratory centre depression, pulmonary disease, pneumonia, flail chest

37
Q

what is respiratory alkalosis?

A

hypoxia, severe anaemia, pulmonary disease, PE, increased rep drive, hepatic failure, hyperventilation

38
Q

what are signs of intravascular volume depletion?

A
  • hypotension, shock, hypoperfusion, AKI, tachycardia, decreased UO, poor cap refill, orthostatic hypotension
39
Q

what are signs of fluid overload?

A
  • impaired oxygenation
  • oedema
  • hypertension
  • organ congestion
  • increased JVP
40
Q

what are causes of hyperkalaemia?

A
  • renal failure
  • activation of alpha adrenoreceptors
  • haemolysis
  • thrombocythaemia
  • ischaemia
  • rhabdomyolysis
  • potassium sparing diuretics, ACE inhibitors
  • addisons disease
  • metabolic acidosis
41
Q

what is the effect of aldosterone on potassium?

A

increases excretion

42
Q

what are causes of hypokalaemia?

A
  • activation of beta 2 adrenoreceptors
  • loop diuretics
  • thiazide diuretics
  • vomiting
  • diarrhoea
  • cushings syndrome
  • conns syndrome
  • alkalosis
43
Q

what are causes of hyponatraemia?

A
  • hyperglycaemia
  • diuretics
  • vomit and diarrhoea
  • addisons
  • ectasy
44
Q

what are causes of hypernatraemia?

A
  • diuretics

- diabetes insipidus

45
Q

what ECG changes happen with hyperkalaemia?

A
  • flattening of P waves, tall tented T waves, wide QRS
46
Q

what are ECG changes in hypokalaemia?

A

flat T waves, ST depression, prominent U wave

47
Q

how do you manage volume depletion?

A
  • give 0.9% saline
  • colloid solutions like albumin can be used
  • if mild give oral
48
Q

what is the management of hyponatraemia?

A
  • vasopressin antagonists
  • if hypovolaemic: give NaCl and stop diuretics.
    euvolaemic- restrict fluid, stop diuretics. give thyroxin and consider sodium and demeclocycline
49
Q

what is the management of hypernatraemia?

A

IV dextrose

50
Q

what is the management of hyperkalaemia?

A
  • 10% 10ml calcium gluconate

- 50%dextrose with 10 units of insulin

51
Q

what is the emergency management of hypokalaemia?

A
  • <2.5- give max IV dose

2. 5-3 take ECG and give IV 80-120mmol over 24 hours

52
Q

how would you investigate a suspected UTI?

A
  • clinical history
  • MSU sample
  • urine dip stick
53
Q

what is the management of a UTI?

A
  • three day course of trimethoprim

5 day course of nitrofurantoin

54
Q

what are the rifle stages of AKI?

A

Stage one: serum creatinine rise of>26,4
Stage two: 2-3x increase in creatinine
Stage three: creatinine >354

55
Q

what are the risk factors for acute renal failure?

A
  • elderly
  • peripheral arterial disease
  • CKD
  • ACE inhibitors, NSAIDS, aminoglycosides
  • intraperitoneal surgery
  • liver failure
  • diabetes
  • hypertension
  • heart failure
  • sepsis
  • hypovalaemia
  • rhabdomyolysis
56
Q

who is at high risk of developing hypertension?

A
  • family history
  • obesity
  • sodium high diet
  • long term alcohol
  • low birth weight
  • black africans
57
Q

what is the pathology behind accelerated hypertension?

A
  • there is vascular fibrinoid necrosis and loss of precapillary arteriolar autoregulation.
    after 180/110 autoregulation control is lost
58
Q

what are the three possible criteria for diagnosing AKI?

A
  • UO: <0.5mg/kg/hour
  • 50% or greater rise in serum creatinine
  • rise in creatinine of 26 in 48 hours
59
Q

what is the urine sodium levels in prerenal causes of AKI?

A

<20 as the kidneys are still working well enough to resorb it

60
Q

what are the indications for dialysis?

A 
Acidosis <7.2
Electrolytes K>7
Ingested toxins (barbiturates, lithium, alcohol, salicylates, theophylline
Oedema
Ureaemia
61
Q

what are the diagnostic criteria for CKD?

A
  • impaired renal function for over 3 months

- GFR <60

62
Q

What are causes of CKD?

A
  • glomerulonephritis
  • diabetic nephropathy
  • chronic pyelonephritis
  • adult PKD
  • HTN
63
Q

what does the EGFR using modification of diet in renal disease consider?

A
  • C: serum creatinine
  • A: age
  • G: gender
  • E: ethnicity
64
Q

what is key in stage 3 CKD?

A
  • PTH levels start to raise and there is low vit D.
65
Q

what are features of autosomal dominant polycystic kidney disease?

A
  • hypertension
  • UTI
  • abdo pain
  • renal stones
  • haematuria
  • CKD
66
Q

what is nephrotic syndrome a triad of?

A
  • proteinuria >3g/24 hr
  • hypoalbuminaemia
  • oedema
67
Q

what are signs of nephrotic syndrome?

A
  • frothy urine
  • high cholesterol
  • hypercoaguable
  • oedema
68
Q

what are causes of nephrotic syndrome?

A
  • diabetic nephropathy
  • SLE
  • sjogrens
  • multiple myeloma
  • vasculitis
69
Q

what is minimal change disease?

A

Affects children causing nephrotic syndrome

Foot process death

70
Q

what is focal segmental glomerulisclerosis?

A

there is dead foot processes and scarring.

Causing nephrotic syndrome in adults

71
Q

what are causes, typically in children, of nephritic syndrome?

A
  • IgA nephropathy, post streptococcal glomerulonephritis, haemolytic uraemic syndrome, henoch schonelein purpura
72
Q

when does post strep glomerulonephritis occur?

A

around 7 days after having a strep a infection

73
Q

when does IgA nephropathy happen causing glomerulonephritis?

A
  • 1-2 days after a URTI
74
Q

what is henoch schonelein purpura?

A

A continuation of IgA nephropathy where it isn’t just the kidneys affected but get vasculitis everywhere

75
Q

what are causes of glomerulonephritis in adults?

A

good pastures syndrome
SLE
rapidly progressive glomerulonephritis

76
Q

what are the investigation findings in goodpastures syndrome?

A
  • IgGs against the basement membrane

- crescent cells

77
Q

what are investigations findings of acute tubular necrosis?

A
  • muddy brown RBC Cast

- urinary sodium over 20

78
Q

how is hypertension management different in diabetic patients?

A
  • first line is always ACE inhibitors

- beta blockers should be avoided

79
Q

what are the targets in diabetics for BP?

A
  • if end organ damage: 130/80

no end organ damage: 140/80

80
Q

what is responsible for a high anion gap?

A

K: ketones (DKA, alchol)
U- uraemia; renal failure
Lactate- shock, hypoxia, burns, metformin
T- toxins; salicylates or methanol

81
Q

what calcium hydroxylation takes place in the kidney?

T year LOBs medicine (11 decks)

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