Renal Facts

Question 1

CKD STAGE 1

Answer 1

GFR greater than 90

Question 2

Define stage 1 AKI

Answer 2

Creatinine rise 1 to 1.5x baseline OR a rise of 26.5 umol/L (0.3g/dL)

Urine 0.5 ml/kg/hr for 6-12 hrs

Question 3

Stage 2 AKI

Answer 3

Creatinine 2 - 2.9x baseline

Urine 0.5ml/kg/hr for 12 hours

Question 4

Stage 3 AKI

Answer 4

Creatinine 3x baseline or a rise of 353.6 umol/L (4mg/dL)

Urine of 0.3 ml/kg/hr for more than 24 hours

Or

Anuria for 12

Question 5

Rifle - Risk

Answer 5

Creatine 1.5x
GFR decrease by 25%

Urine 0.5 ml/kg/hr for 6 hours

Question 6

Rifle - injury

Answer 6

Creatinine 2x baseline
GFR decrease by 50%

Urine 0.5 for 12 hours

Question 7

Rifle - failure

Answer 7

Creatinine 3x base
GFR decrease by 75%

Or creatinine greater than 4mg/dL

Urine 0.3 mls/kg/hr for 24 hours
Anuria for 12

Question 8

Rifle - loss

Answer 8

Persistent ARF WITH complete loss of function for more than 4 weeks

Question 9

Rifle - end stage

Answer 9

End stage disease for more than 3 months

Question 10

CKD stage 2

Answer 10

60-89

Question 11

CKD stage 3

Answer 11

30-59

Question 12

CKD stage 4

Answer 12

15-29

Question 13

CKD stage 5

Answer 13

Less than 15 mls/min/1.73 m2 body area

Question 14

Causes of a normal anion gap metabolic acidosis

Answer 14

Diarrhoea
Ileostomy
Renal tubular acidosis
Parenteral nutrition
Colonic ureteric implant/diversion

Question 15

Causes of a raised anion gap metabolic acidosis

Answer 15

Lactic acidosis
Ketoacidosis - diabetes, starvation, alcohol excess
AKI/CKD
Methanol
Ethylene glycol
Salicylate poisoning

Question 16

Anticoagulation methods in RRT

Answer 16

Unfractionated heparin - 2litres crystalloid wth 5000 units heparing

Infuse at 5-10 IU/hour aiming for APTT ratio of 1.5-2

Prostacyclin PGI2. Inhibits platelet aggregation. Short acting, minimal systemic effects

Citrate - chelates calcium, reducing clotting cascade and platelet aggregation. Calcium infused as it leaves the filter

Citrate returning to the body is metab to bicarb in the liver

Question 17

What is the required APTT ratio for heparinisation

Answer 17

1.5-2

Question 18

Indications for RRT

Answer 18

Classic:
Symptomatic uraemia
Rapidly climbing urea and creatinine
Refractroy K
Severe met acid
Refractory pulm oedema
Oliguria

Non renal
Fluid balance - cardiac failure
Toxin clearence
Electrolytes correction
Temp control
Cytokines