Renal Function 2 Flashcards
Define timing of AKI vs CKD
AKI = abrupt CKD = longstangding
Define reversibility of AKI vs CKD
AKI = reversible CKD = irreversible
What is treatment targeted to in AKI vs CKD
AKI = reversal of disease CKD = prevention of complication of CKS, limiting progression
Define AKI
Rapid reduction in kidney function, leading to inability to maintain electrolyte, acid base and fluid haemostats
How do you categorise AKI
Pre renal
Renal
Post renal
What are causes of pre-renal AKI classified as
Due to REDUCED RENAL PERFUSION
- generalised reduction in perfusion (shock, hypovolaemia)
- selective renal ischaemia (renal artery stenosis, drugs)
What are drugs that decrease renal blood flow, thereby causing reduced renal perfusion?
NSAIDS
Calcineurin inhibitors
ACE inhibitors, ARBs
Diuretics
What can prolonged pre-renal AKI lead to?
Acute tubular necrosis (ischaemic injury)
What is the hallmark of post-renal AKI
Physical obstruction off urine flow
What are causes of post renal AKI
Intra renal obstruction Ureteric obstruction (BILAT) Prostatic /urethral obstruction Blocked urinary catheter
What are intrinsic renal AKI causers
Vascular disease e.g. vasculitis, amyloidosis
Glomerular disease e.g. glomerulonephritis
Tubular disease e.g. ATN
interstitial disease e,g. analgesic nephropèathy, from NSAIDS
What are causes of direct tubular injury ?
TOXINS
Endogenous:
- myoglobin (rhabdomyolysis)
- immunoglobulins (myeloma)
Exogenous:
- Aciclovir
What are 2 key measures to identify AKI
Creatinine (GFR)
Urineo Output
How many stages of CKD are there?
5
What are the most common causes of CKD?
DM
Atherosclerotic renal disease
Hypertension
What are consequences of CKD?
Failure of homeostatic function
- acidosis
- hyperkalaemia
Failure of hormonal function
- anaemia
- renal bone disease
Cardiovascular disease
Uraemia, death
How does CKD cause metabolic acidosis?
Failure of renal excretion of protons
How do you treat metabolic acidosis in CKD=?
Oral sodium bicarb
How does CKD cause anaemia?
Due to progressive decline of EPO producing cells with the loss of renal parenchyma
What kind of anaemia does CKD cause
normocuytic normochromic
HOW DO YOU treat CKD anaemia?
EPO injection (EPO alpha, beta, darbopoetin)
What is the event most likely to kill someone with CKD?
CVD
due to excess off heavily clacified plaques depositing on the blood vessels
What are 3 treatment options for those qwiutg progressive CKD?
Transplant
Haemodyalisis
Peritoneal dialysis
