Renal CBD learning points useful for F! Flashcards
complications of AKI causing people to die
Acidoditic
High potassium
Fluid overload - pulmonary oedema
= reasons for dialysis
AEIOU: A—acidosis; E—electrolytes principally hyperkalemia; I—ingestions or overdose of medications/drugs; O—overload of fluid causing heart failure; U—uremia leading to encephalitis/pericarditis.
what is calciphylaxis
calcium products build up in the small blood vessels in and around the skin, blocking the flow of blood) - more a product of patients on dialysis
at what CKD stage does hyperphosphataemia occur as well as this leading to osteomalacia due to low levels of vitamin d so reduced absorption of Ca from the gut as well as kindeys not being able to excrete phsopahte dragging ca from bone
CKD 4-5
what is aki
AKI is usually caused by a sudden event, such as a serious infection, blood loss, or certain medications. CKD is usually caused by long-term conditions, such as diabetes or high blood pressure
what is an active urine dip
positive for both blood and protein
prerenal causes of aki so what qs gonna ask to
shock
fluid
infection and sepsis - biggest
vomit and diarrhoea leading to dehydration
cardiac failure
renal artery stenosis
vascultiits - as well as intrarenal
could be specfic sx for vascultiis or just kidney as can affect many other systems - may just feel tired as increasing uraemia.
intrinsic causes of aki
toxins and drugs
glomerulonephritis
ATN and AIN
vascultiis - ask about joint problems, nose bleeds, breathing, eyes
post renal causes of aki
stone blockage causing back up and hydronephrosis
are you weeing normally , prostate sx? problems at night, stop and start, feel you fully empty your bladder?
for every person that comes through the door with AKI what should you do now - ROUNDUP
Do ROUND UP
Repeat UandE - need to know trends of bloods - make sure repeat UandE
Rule out obstruction - history and examination and imaging - bladder percussion and bladder scan nad record residual -USS will say hydronephrosis ( problem with drainage)
Urinalysis - dip urine and acute renal screen ( screening for renal causes of AKI - ANCAs, ( elisa antibodies), myeloma screen ( scrum free light chains in blood/bence jones which is light chains in urine) acute screen also cover lupus serology ( double stranded Ana , complement, goodpasture’s ( GBM) - early diagnosis changes outcome
News score of 5 - look at obvs - has this patient got sepsis or infection - do cultures or give abx
Dry or wet? Or ok - monitor weight as could be putting on fluid - continually reassess - if wet ask for help will probs need furosemide , daily weights
Urinary output and fluid balance charts - really difficult for nurses to do this , if anuric or oliguric need to involve nephrology
Prescriptions reviewed, anything that will augment aki , dose adjustment ( renal drug handbook- ask the pharmacist- you just need to note they have such a low level of kidney function, LMWH need reducing)digoxin accumulates so measure a level in AKI
HLA matching for a renal transplant the relative importance of the HLA antigens are as follows
DR > B > A
hyperactue caused by
ABO or HLA
need to remove
Acute - 6 motnhs
HLA cell mediated - risng creaitine pyuria and proteinuira - steroids
Chronic graft - fibrosis of kidney - normal cause is
recurrent of original disease that lead to transplant
Causes of transient or spurious non-visible haematuria
urinary tract infection
menstruation
vigorous exercise (this normally settles after around 3 days)
sexual intercourse
Causes of persistent non-visible haematuria
cancer (bladder, renal, prostate)
stones
benign prostatic hyperplasia
prostatitis
urethritis e.g. Chlamydia
renal causes: IgA nephropathy, thin basement membrane disease
