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CP3 Medicine > Renal - AKI and CKD > Flashcards

Renal - AKI and CKD Flashcards

1
Q

Role of renal corpuscle

A

Produces glomerular filtrate

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2
Q

Role of Proximal convoluted tubule

A

Isotonically reabsorbs 2/3 Na+ + H2O

Also absorbs HCO3- + glucose

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3
Q

Role of LH - descending limb

A

Passive transport of H2O by increased medularly osmolarity

Tubular fluid concentrated

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4
Q

Role of LH - ascending limb

A

Reabsorbs 20% Na

Dilutes tubular fl b/c H2O impermeable

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5
Q

Role of DCT

A

Reabsorbs remaining H2O, Na+, HCO3-
Secretes K+
Synthesises HCO3-

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6
Q

Role cortical collecting duct

A

Fine adjustments to [ ]
Principle cells secrete K+
Intercalated cells secrete H+ into lumen + synthesise HCO3- for blood

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7
Q

Role medullary collectign duct

A

Draws H2O + urea out b/c hypertonic interstitium

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8
Q

2’ functions of kidney (3)

A

Secretes EPO (stim erythropoeisis)
Secetes renin to incr BP
Hydroxylation/activation vit D

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9
Q

Anatomical position of kidneys

A

L1-3

Retroperitoneally

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10
Q

What is an AKI

A

Acute decline in GFR over 48hrs

= a sudden reversible deterioration in kidney fct

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11
Q

What are NICE’s req for an AKI to be present (3)

A

UO <0.5ml/kg/hr 6hrs
>50% rise creatinine over 7 days
>26micromol rise creatinine over 48hrs

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12
Q

AKI stage 1

A

Se Creatinine: 150-200% incr
or
25 umol/l incr in 48hr
UO <0.5ml/kg/h 6hr

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13
Q

AKI stage 2

A

Se creatinine 200-300% incr

Or <0.5ml/kg/h 12 hr

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14
Q

AKI stage 3

A

Se creatinine >300% incr

UO <0.3ml/kg/hr 24hr or anuria 12hr

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15
Q

Who is AKI more common in

A

Elderly pt w/ pre-existing CKD, DM, HTN, sepsis or hypovolaemia

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16
Q

What Sx does AKI usually PS with

A

ASYMP

or oliguria

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17
Q

2’ Sx AKI (3)

A

Uraemia –> Vom, pruritis, encephalopathy
Hyperkalaemia
Pulm oedema

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18
Q

How are the causes of AKI split up?

A

Into :
pre renal
renal
post renal causes

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19
Q

What is pre-renal AKI to do with

A

Perfusion

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20
Q

What type of AKI is most common in hospital pt

A

Pre-renal

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21
Q

What are the 2 main causes of pre-renal AKI

A

SHock

Renovascular obstruction

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22
Q

E.g.s of conditions –> shock + pre-renal AKI

A

Hypovolaemic shock - haemorrhage/fl loss
Cardiogenic: CCF, valve disease
Distributive
Sepsis

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23
Q

E.g.s of conditions –> renovsacular obstruction + pre-renal AKI

A

Embolus
Aortic dissection
RAS
Thrombosis

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24
Q

If interuption to blood supply of kidneys is prolonged, what occurs

A

ATN

= Acute tubular necrosis

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25
Q

Urine osm, urine Na + concentrating powers - initial pre-renal AKI

A

Urine osm = high (>500)
Urine Na = low (<25)
Concentrating powers = retained

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26
Q

Urine osm, urine Na + concentrating powers - ATN

A

Urine osm = isotonic w/ plasma (<400)
Urine Na = high (>40)
Concentrating powers = lost

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27
Q

What are post-renal AKI’s due to ?

A

Obstruction to outflow urinary tract

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28
Q

Where is the blockage often in post-renal AKI?

A

Ureters

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29
Q

E.g.s of conditions –> bladder outflow obstruction + post-renal AKI (4)

A

Prostatic enlargement
Urethral strictures
Phimosis / paraphimosis

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30
Q

What is the cause of 85% renal AKI?

A

Acute tubular necrosis (post ischaemic or Dx)

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31
Q

Other causes of renal AKI

A

Interstitial nephritis
Glomerular disease
Intratubular obstruction
Vascular disease

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32
Q

Drugs causing ATN

A

Aminoglycosides
Cephalosporin
Radiological contrast mediums
NSAIDS

33
Q

Toxins causing ATN

A

Heavy metal poisoning
Myoglobinuria
HUS

34
Q

Appearance kidneys ATN

A

Enlarged
Pale
Markings are lost

35
Q

Where does ischaemic damage start in ATN

A

In cortex

36
Q

Which parts of the nephron are most commonly affected by ATN

A

PCT

Ascending LH

37
Q

What does myoglobinuria follow

A

Rhabdomyolysis

38
Q

Appearance urine myoglobinuria q

A

Dark urine

39
Q

Cause HUS in children

A

Diarrhoeal illness b/c verotoxin prod by E.Coli 0157

40
Q

Cause HUS adults

A

FOllowing URTI

41
Q

Sx HUS

A

Thrombocytopenia –> purpura
Haemolyis
ATN

42
Q

Prognosis - HUS in kids

A

Usually recover in a few weeks

43
Q

Prognosis HUS in adults + Mx

A

Poor

Mx supportively w/ dialysis

44
Q

What is interstitial nephritis caused by

A

Abx
Diuretics
Allopurinol
PPIs

45
Q

How does interstitial nephritis differ from ATN

A

Damage bypassses BM to cause damage to interstitium

46
Q

Mx interstitial nephritis

A

Withdraw Dx

Short course PO steroids

47
Q

Ix AKI/CKD

A 
Obs incl BP 
O/E - palpable bladder 
Bloods - FBC, U+E, HCO3- 
PO4-, CRP, clotting, CK
Nephritic screen
ABG
Urine Dip + MCS
ECG
Renal USS
48
Q

What is included in a nephritic screen? (6)

A 
ANCA + antiGBM
ANA + dsDNA + complement studies 
Immunoglobulins Se electrophosis 
RF
Hep B/C - MCGN
ASO (post streptococcal)
49
Q

Common electrolyte abnormalities in AKI (5)

A 
Uraemia 
Hyperkalaemia 
Hypernatraemia
Met acidosis 
Hypokalaemic/hypophosphataemia (> in CKD)
50
Q

Causes hyperkalaemia (5)

A

AKI/CKD
Drugs - K sparing diuretics, ACEi, NSAIDs
Acidosis
Addisons/tumour lysis syndrome/burns

51
Q

Causes of pseudohyperkalaemia (3)

A

haemolysis
incorrect order blood draw
sample taken from drip aarm

52
Q

Hyperkalaemia - changes on ECG (3)

A

Tall tented T waves
Widened QRS
Flattened P waves/prolonged PR interval

53
Q

If hyperkalaemia is unTx, what cardiac condition can develop

A

VF/TachyC

54
Q

Mx K+ >6.5

A

Continuous ECG
Stabilise heart: 10ml 10% Ca gluconate IV
50ml 50% glucose + 10U ACTRAPID insulin large vv 30 mins
+/- 10mg salbutamol nebs
If pH <7.2 - NaHCO3- IV
Tackle underlying cause

55
Q

Stage 1 CKD

A

eGFR 90+

Normal kidney fct but urine findings/structural abnorm or genetic traits that point to kidney disease

56
Q

Stage 2 CKD

A

60-89
Mildly reduced kidney fct
+ other findings pointing to kidney disease

57
Q

Stage 3 CKD

A

30-59

Moderately reduced kidney function

58
Q

Stage 4 CKD

A

15-29

Severely reduced kidney function

59
Q

Stage 5 CKD

A

<15

V severe or established RF

60
Q

Aetiology CKD (8)

A 
DM
HTN
Chronic glomerulonephritis 
Chronic pyelonephritits 
Obstructive uropathy 
Renovascular disease 
Dx - l term NSAIDs
PKD
61
Q

Sx CKD (7)

A 
Asymp till advanced 
Polyuria/nocturia 
Restless leg syndrome 
Fatigue/anorexia 
Sexual dysfunction 
Nausea + pruritis 
Pedal oedema + pulm oedema
62
Q

Signs CKD (3)

A

Pallor
HTN/fl overload
Pericardial rub

63
Q

Ix CKD (9)

A 
Cockcroft Gault eq
Bloods: FBC, U+E. LFT, Ca, PO4, PTH, glucose 
Urinalysis +MCS
24hr protein/creatinine clearance 
CXR
Renal USS
64
Q

Conditions who should be offered testing for CKD (7)

A 
DM
HTN
CV disease
Structural renal disease/stones/BPH
FHx
Haematuria
Multisystem disease
65
Q

Mx CKD (4)

A

ACEi = 1st line
Aim for BP <130/80
Start statin + low dose aspirin (CV prevention)

66
Q

2nd line Mx CKD (3)

A

Recombinant EPO
Ca/Vit D
K+ restriction

67
Q

How does renal anaemia occur

A

Kidney norm secretes EPO in response to hypoxia

CKD - loses ability to secrete EPO partially –> Anaemia

68
Q

Mx renal anaemia

A

Recombinant EPO added to dialysis

69
Q

How does renal bone disease occur

A

Kidneys norm prod 1-a-hydroxylase
Which activates Vit D
Which increases Ca
Hence if low –> osteomalacia –> osteopenia

70
Q

Tx of renal bone disease (3)

A

Restrict dietary phosphase
Phosphate binders (calcichew)
AdCal (Ca + Vit D)

71
Q

Haemodialysis - how often do pt have to have it

A

4hrs 3xw

72
Q

Main issue w/ haemodialysis

A

Haemodynamic instability during dialysis

73
Q

What is haemofiltration

A

Variant of dialysis

Blood = continuously filtered across highly permeable membrane

74
Q

What is peritoneal dialysis

A

Pt instills 2L isotonic/hypertonic solution –> peritneal cavity
Equilibrates w/ blood in peritoneal capillaries
Fl = drained after 2hrs, 3-4times a day

75
Q

Risk peritoneal dialysis

A

Infection

Peritonitis

76
Q

Annual % mortality dialysis

A

20%

77
Q

Common complications of dialysis (5)

A 
Infection 
CVD
Renal bone disease/anaemia
Bleeding tendencies
Incr risk renal malignancy
78
Q

Complications - renal transplant (4)

A

Operative
Rejection
Ciclosporin/lacrolimus toxicity
Infection/malig b/c immunosuppression

79
Q

Prognosis Renal transplant

A

80-95%

CP3 Medicine (29 decks)

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