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Yr 5 - Renal & Urology > Revision - CKD & AKI > Flashcards

Revision - CKD & AKI Flashcards

1
Q

What ACR is defined as clinically important proteinuria?

A

≥3 mg/mmol

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2
Q

What ACR is:
a) Normal to mildly increased
b) Moderately increased
c) Severely increased

A

a) <3
b) 3-30
c) >30

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3
Q

When can a diagnosis of CKD be made?

(2)

A

When there are consistent results of 3 months of either:

1) eGFR <60

or

2) ACE >3 mg/mmol

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4
Q

How long must features be present for for CKD diagnosis?

A

At least 3m

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5
Q

What is accelerated progression in CKD?

A

A sustained decline in eGFR within 1 year of either >25% or 15 ml/min

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6
Q

Complications of CKD?

A

1) anaemia

2) renal bone disease

3) CVD

4) peripheral neuropathy

5) end-stage kidney disease

6) dialysis related complications

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7
Q

At what eGFR does anaemia typically become apparent in CKD?

A

when the GFR is less than 35 ml/min (other causes of anaemia should be considered if the GFR is > 60 ml/min).

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8
Q

What does anaemia in CKD predispose to?

A

To the development of LV hypertrophy (increase in mortality)

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9
Q

Bone profile results in renal bone disease?

A

1) low vit D

2) high phosphate

3) low calcium

4) 2ary hyperparathyroidism

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10
Q

Cause of increased phosphate in CKD?

A

Reduced phosphate excretion by kidneys

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11
Q

Characteristic xray finding in renal bone disease?

A

Rugger jersey spine

This involves sclerosis of both ends of each vertebral body (denser white) and osteomalacia in the centre of the vertebral body (less white).

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12
Q

How can ACEi affect creatinine?

What rise is acceptable?

A

As these drugs tend to reduce filtration pressure a small fall in glomerular filtration pressure (GFR) and rise in creatinine can be expected.

NICE suggest a rise in creatinine of up to 30% is acceptable.

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13
Q

When are ACEi offered to:

a) patients with diabetes
b) patients with HTN
c) anyone

A

a) ACR >3
b) ACR >30
c) ACR >70

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14
Q

2 drugs used for proteinuria in CKD?

A

1) ACEi (or ARBs)

2) SLGT-2 inhibitors

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15
Q

What is the SGLT-2 inhibitor licensed for CKD?

A

Dapagliflozin

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16
Q

Criteria for diagnosing an AKI?

a) Rise in creatinine
b) Urine output

A

a) 50% in 7 days or 25micromol/L in 48h

or

b) urine output <0.5ml/kg/hr for 6 hours

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17
Q

Pre-renal causes of AKI?

A

1) Dehydration

2) Shock e.g. sepsis

3) Hypovolaemia e.g. D&V

4) Renal artery stenosis

5) HF

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18
Q

Renal causes of AKI?

A

1) Rhabdomyolysis

2) ATN

3) AIN

4) Glomerulonephritis

5) Tumour lysis syndrome

6) HUS

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19
Q

Dose of calcium gluconate given to stabilise the cardiac membrane in hyperkalaemia?

A

IV 10ml 10% calcium gluconate

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20
Q

What is used for the removal of potassium from the body in hyperkalaemia?

A

Calcium resonium

(or dialysis)

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21
Q

Management of all patients with suspected AKI secondary to urinary obstruction?

A

Prompt review by urologist

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22
Q

What is the most common intrinsic cause of AKI?

A

ATN

23
Q

Via what 2 ways can damage to kidney cells occur in ATN?

A

1) Ischaemia due to hypoperfusion (e.g., dehydration, shock or heart failure)

2) Nephrotoxins (e.g. gentamicin, radiocontrast agents or cisplatin)

24
Q

What confirms ATN on urinalysis?

A

Muddy brown casts (renal tubular epithelial cells)

25
Q

Indications for dialysis?

AEIOU

A

A - Acidosis

E - Electrolyte imbalance e.g. treatment resistant hyperkalaemia

I - Intoxication e.g. lithium, ethylene glycol

O - Oedema (e.g. pulmonary)

U - Uraemia

26
Q

What 2 complications can uraemia cause?

A

1) Encephalopathy
2) Pericarditis

27
Q

Define azotemia

A

Elevation, or buildup of, nitrogenous products (BUN-usually ranging 7 to 21 mg/dL), creatinine in the blood, and other secondary waste products within the body.

28
Q

Urine sodium in pre-renal uraemia vs ATN?

A

Pre-renal uraemia: <20 mmol/L i.e. low (kidneys hold on to sodium to preserve volume)

ATN: >40 mmol/L i.e high

29
Q

Urine osmolality in pre-renal uraemia vs ATN?

A

Pre-renal uraemia: >500 (high i.e. very conc)

ATN: <350 (low)

30
Q

Response to fluid challenge in pre-renal uraemia vs ATN?

A

Pre-renal uraemia: Good

ATN: Poor

31
Q

Serum urea:creatinine ratio in pre-renal uraemia vs ATN?

A

Pre-renal uraemia: Raised

ATN: Normal

32
Q

Why are potassium sparing diuretics contraindicated in AKI?

A

Due to risk of hyperkalaemia

33
Q

What is TURP syndrome?

A

A rare and life-threatening complication of transurethral resection of the prostate surgery.

34
Q

Cause of TURP syndrome?

A

Irrigation with large volumes of glycine (hypo-osmolar) –> systemically absorbed when prostatic venous sinuses are opened up during prostate resection.

35
Q

Key feature of TURP syndrome?

A

Hyponatraemia

36
Q

What surgery time is a risk factor for TURP syndrome?

A

> 1 hour

37
Q

Is warfarin safe to continue in an AKI?

A

Yes

38
Q

What is the most common cause of death in CKD patients on haemodialysis?

A

IHD

39
Q

Which NSAID can be continued in AKI?

A

Aspirin at cardioprotective dose

40
Q

Give 7 causes of hyperkalaemia

A

1) AKI
2) CKD
3) Rhabdomyolysis
4) Massive blood transfusion
5) Tumour lysis syndrome
6) Adrenal insufficiency (Addison’s)
7) Drugs e.g. potassium sparing diuretics, ARBs/ACEi

41
Q

What can cause pseudohyperkalaemia during sampling?

A

Haemolysis (rupture of blood cells) during sampling –> recommend a repeat sample.

42
Q

Give 4 ECG changes in hyperkalaemia

A

1) Tall tented T waves
2) Broad QRS
3) Prolonged QT
4) Flattened/absent P waves

43
Q

Is hyperkalaemia associated with acidosis or alkalosis?

A

Acidosis

44
Q

Beta blockers vs beta agonists (e.g. salbutamol) in hyperkalaemia?

A

Beta blockers –> interfere with potassium transport into cells (can cause hyperkalaemia in patients with renal failure)

Beta agonists –> cause intracellular shift of K+ (fall in potassium) hence used in hyperkalaemia treatment

45
Q

In hyponatraemia causes, what 3 tests should be ordered?

A

1) urine osmolality
2) plasma osmolality
3) urinary sodium

46
Q

Give some causes of hyponatraemia if the patient is hypovolaemic w/ urinary sodium >20 mmol/l?

A

This is due to renal losses:

  • Addison’s
  • Renal failure
  • Diuretics
47
Q

Give some causes of hyponatraemia if the patient is hypovolaemic w/ urinary sodium <20 mmol/l?

A

This is due to loss NOT by kidneys:

1) D/V
2) SBO
3) Burns
4) Excessive sweating
5) Fistulae

48
Q

Give some causes of hyponatraemia if the patient is euvolaemic

A

If raised urine osmolality –> SIADH (most common)

If not raised urine osmolality:
1) water intoxication
2) severe hypothyroidism
3) Glucocorticoid insufficiency

49
Q

Give some causes of hyponatraemia if the patient is hypervolaemic

A

1) HF
2) Renal failure
3) Cirrhosis
4) Neprotic syndrome

50
Q

Give 4 causes of hypernatraemia

A

1) Dehydration

2) Diabetes insipidus

3) Excess IV saline

4) Osmotic diuresis e.g. HHS

51
Q

Hypokalaemia can be associated with alkalosis or acidosis.

Give some causes of hypokalaemia with alkalosis

A

1) Vomiting

2) Thiazide diuretics

3) Cushing’s

4) Conn’s (primary hyperaldosteronism)

52
Q

Give some causes of hypokalaemia with acidosis

A

1) diarrhoea
2) renal tubular acidosis
3) acetazolamide
4) partially treated diabetic ketoacidosis

53
Q
A

Yr 5 - Renal & Urology (6 decks)

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