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Y3 Medicine > Renal - CKD and AKI > Flashcards

Renal - CKD and AKI Flashcards

1
Q

define AKI

A

sudden decerase in kidney function

measured by an increase in serum creatinine or decreased urine output

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2
Q

what is stage 1 AKI?

A

serum creatinine 1.5-1.9 x baseline

or urine output < 0.5 ml/kg/h for 6-12 hours

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3
Q

what is stage 2 AKI?

A

serum creatinine 2.0-2.9 x the baseline or urine output <0.5 ml/kg/hour for >12 hours

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4
Q

what is stage 3 AKI?

A

serum creatinine 3 x the baseline
or urine output <0.3 ml/kg/hour for >24 hours or anuria for >12
or initiation of renal replacement therapy

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5
Q

what are the different categories of causes of AKI?

A

pre-renal AKI
intra-renal AKI
post-renal AKI

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6
Q

what are the causes of pre-renal AKI?

A
  • Volume deflation - haemorrhage, severe vomiting, burns
  • Effective volume depletion - sepsis, heart failure, cariogenic shock
  • Renal hypoperfusion - renal artery stenosis, abdominal aortic aneurysm
  • NSAIDs, ACEi, ARBs
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7
Q

what are the causes of intra-renal AKI?

A
  • ischaemic injury
  • nephrotoxic injury
  • immune-mediated injury
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8
Q

what are the causes of post-renal AKI?

A
  • obstruction to urinary collecting system
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9
Q

what is the presentation of AKI?

A
  • reduced urine output
  • signs of the cause of AKI (e.g. tachycardia, hypotension, vomiting)
    signs of volume overload due to impaired salt and volume regulation by the kidneys (orthopnoea, peripheral oedema)
  • electrolyte imbalances
  • acid-base disturbance
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10
Q

what investigations would you carry put when suspecting AKI?

A
  • urine dipstick (can post towards cause e.g. proteinuria + haematuria suggests glomerular injury; haematuria suggests obstruction or tumours and leucocytes suggest infection or nephritis)
  • catheter shows decreased urine output
  • serum creatinine and urea (increased)
  • urea and electrolytes (high serum potassium)
  • ABG (metabolic acidosis)
  • Urine culture
  • FBC (anaemia can suggest CKD or blood loss and leucocytosis can suggest infection)
  • Ultrasound to rule out obstruction and show underlying CKD
  • consider an ECG due to possible changes due to hyperkalaemia
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11
Q

how would you manage AKI?

A
  • If hypovolaemic, fluid bolus of 250-500 mL 0.9% NaCl + a vasopressor (dopamine or adrenaline)
  • if euvolaemic give maintenance fluids and if hypervolaemic consider diuretics
  • medication review, stop nephrotoxic drugs and antihypertensives if there is hypotension
  • monitor urine output, urea and electrolytes, creatinine and fluid chart
  • treat underlying cause
  • bladder catheterisation if obstructive cause
  • consider renal replacement therapy if indicated (usually haemodialysis)
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12
Q

define chronic kidney disease

A

GFR < 60 mL/min for at least 3 months

or persistent proteinuria or haematuria

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13
Q

how is CKD staged?

A

according to GFR

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14
Q

what is stage 1 CKD?

A

kidney damage with normal or increased GFR (GFR >90 mL/min)

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15
Q

what is stage 2 CKD?

A

Kidney damage with a mild decrease in GFR (60-89)

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16
Q

what is stage 3 CKD?

A

GFR 30-59

17
Q

what is stage 4 CKD?

A

GFR 15-29

18
Q

what is stage 5 CKD?

A

kidney failure

GFR<15 or dialysis

19
Q

what are the causes of CKD?

A
  • diabetes and hypertension are the most common causes
  • chronic pyelonephritis
  • polycystic kidney disease
20
Q

what is the presentation of CKD?

A
  • fatigue
  • oedema
  • nausea, vomiting
  • pruritus
  • anorexia
  • bone disease
21
Q

why can bone disease occur in CKD?

A

phosphate excretion by kidneys is impaired causing increased phosphate levels.
there is decreased active vitamin D (calcitriol) due to kidney disease and therefore decreased calcium.
decreased calcium and calcitriol levels cause increased PTH levels which causes bone resorption- cyst formation and bone marrow fibrosis.

22
Q

why can CKD cause cardiovascular disease?

A

high urea levels can cause uraemia cardiomyopathy.

fluid retention causes LV overload and hypertrophy

23
Q

what investigations are carried out when suspecting CKD?

A
  • urine dipstick (haematuria, proteinuria)
  • blood glucose (diabetes can cause CKD)
  • FBC and haematinics (normocytic anaemia of chronic disease)
  • urea and electrolytes (sodium and potassium abnormalities, increased urea)
  • creatinine and eGFR to stage the CKD
  • bone profile to check for metabolic bone disease (serum Ca, phosphate, Alk Phos, Mg, Vit D and PTH)
  • complement components and autoantibody screen (e.g. for SLE)
  • Ultrasound of renal tract
  • chest Xray (pulmonary oedema)
  • abdominalCT to look for calculi
24
Q

what is the management of CKD?

A
  • stages 1-2 with no uraemia: ACEi or ARB (lisinopril or losartan) for BP control. statin (simvastatin) for cardiovascular protection
  • stages 3-4 with no uraemia: ACEi or ARB + statin +/- Ezetimibe
  • stage 5 or uraemia: dialysis or kidney transplant
  • any above with anaemia: erythropoietin stimulating agent (epoetin alfa) and iron (ferrous sulphate)
  • any above with 2ry hyperparathyroidism (due to low calcitriol and calcium levels): dietary phosphate restriction, phosphate binders, ergocacalciferol (active vitamin D)
  • any above with metabolic acidosis: oral sodium bicarbonate
25
Q

define end-stage renal disease

A

irreversible chronic kidney damage that requires renal replacement therapy for survival

26
Q

what is the presentation of end-stage renal disease?

A

same as CKD:

  • lethargy
  • weight loss
  • pruritus
  • oedema
  • nausea
27
Q

what is the management of end-stage renal disease?

A
  • conservative treatment
  • haemodialysis/peritoneal dialysis/renal transplant
  • vaccination against hepatitis B
28
Q

what are the indications for renal replacement therapy in CKD or end-stage renal disease?

A
  • symptoms of uraemia
  • fluid overload
  • resistant hyperkalaemia
  • resistant metabolic acidosis
  • eGFR < 10mL/min/1.73m^2 (normal is 90-120)
29
Q

what are the signs of uraemia?

A
  • weight loss
  • anorexia
  • nausea/vomiting
  • acidosis
  • hyperkalaemia
  • fluid overload
    (same as CKD signs/symptoms)

Y3 Medicine (8 decks)

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