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Therapeutics > W11 Acute and Chonic Kidney Disease > Flashcards

W11 Acute and Chonic Kidney Disease Flashcards

1
Q

what is glomerular filtration rate

A

rate at which the glomerulus is filtering the blood to form the filtrate

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2
Q

what is the GFR for males

A

90 - 140 ml/min

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3
Q

what is the GFR for females

A

80-125ml/min

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4
Q

what criteria does the substance used to measure GFR need to fufill

A

completely filtered
not re-absorbed
not secreted
not metabolised by the nephron

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5
Q

why is inulin not used even though it meets all the criteria

A

it is not practical as it requires an infusion into the blood

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6
Q

what substance do we use

A

creatinine clearance is measured

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7
Q

what is creatinine

A

it is a chemical waste molecule that is generated from muscle metabolism

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8
Q

what is creatinine produced from

A

creatine which is a molecule of major importance for energy production in muscles

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9
Q

how is creatinine excreted

A

removed from the circulation by filtration and excrted in urine

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10
Q

What does a rising creatinine level indicate

A

kidneys not functioning to their full ability

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11
Q

what potential problem can lack of kidney function cause

A

loss of nutrients from the body

failure to remove toxins

affect drug treatments

affect blood pressure

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12
Q

what is creatinine concentration used for

A

determine sufficiency of kidney function

determine severity of kidney damage

monitor progression of kidney disease

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13
Q

what is creatinine clearance

A

it is a value which indicates the volume of creatinine in ml removed by the kidneys over a period of time per minute

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14
Q

how do we take creatinine clearance

A

blood is taken from the patient

this is measuring the amount of creatinine in the blood plasma

the higher the level of creatinine in the blood the slower the kidneys are working

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15
Q

which equation do we use to calculate the creatinine clearance

A

there are many but the most common is the cockcroft and gault equation

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16
Q

what is the cockcroft and gault equation

A

it states firstly that factor known as F which is a constant

male = 1.23
female = 1.04

F x (140-age) x weight / serum clearnace

units = ml/min

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17
Q

what is eGFR

A

estimated glomerular filtration rate

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18
Q

how is egfr different from gfr

A

the labs calculate egfr using a different equation and its units are

ml/min/1.73m^2

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19
Q

what is eGFR used for

A

can be used to guide dosage for most drugs in patients of an average build

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20
Q

in what patients must creatitine clearance be measured

A

DOACs

Nephrotoxic

> 75 years

Extreme of muscle mass

Drugs that are renally excreted

Narrow therapeutic index drugs

21
Q

what does DOACs stand for

A

direct-acting oral anticoagulants

22
Q

what can serum creatinine be affected by

A

The amount of muscle tissue you have

High protein in diet

Exercise particularly in muscle building

Any injuries involving damage to the muscle

Malnutrition leading to dramatic weight loss

23
Q

What does AKI stand for

A

Acute Kidney Injury

24
Q

what does AKI replace

A

acute renal failure

25
Q

define acute

A

develops over hours or days

26
Q

how common are AKI’s

A

1 in 5 patients in A&E

13-18% of all hospital admission

27
Q

where is AKI common in

A

patients who are at risk or who are acutely ill or who have had a major surgery

28
Q

What are the risk factors for AKI

A 
Age > 75
Previous AKI
PRe existing CKD (eGFR <60ml/kg/1.73m^2)
Heart failure
Atherosclerotic peripheral vascular disease (PVD)
Deabetes mellitus
Liver Disease
Debility and Dementia
29
Q

What are triggers for AKI

A 
Sepsis or Infection
Hypotension
Hypovolaemia (dehydration, bleeding)
Nephrotoxic medications e.g. gentamicin, NSAIDS, iodinated contrast
Anti-Hypertensives
30
Q

What are the 3 classifications of AKI

A

Pre renal
Renal
Post Renal

31
Q

what is a pre renal aki

A

inadequate perfusion, not enough blood at sufficient pressure to allow filtering

32
Q

what is a renal aki

A

cellular damage, damage to the cells that make filtering mechanism possible

33
Q

what is a post renal aki

A

obstruction, urine unable to drain adequately system backed up

34
Q

what are the main causes of a pre renal aki

A

intravascular volume depletion

  • haemorrahge
  • vomiting
  • diarrhoea

decreased arterial pressure

  • heart failure
  • sepsis

nephrotoxic medication

  • ACEIs
  • ARBs
  • NSAIDs
35
Q

what are the main causes of post renal aki

A

kidney stones

benign prostatic hyperplasia

CNS disorders that may affect outflow such as stroke

36
Q

how do we manage a pre renal AKI

A

hydration with IV fluids

37
Q

how do we manage a post renal AKI

A

refer patient to a urologist

38
Q

how do we manage an intrinsic AKI

A

treat the damage if possible

39
Q

what is a general rule of thumb for AKI management

A

hold all nephrotoxic medications

adjust doses of all other medications that are prescribed

40
Q

what can further complications include

A

Hyperkalaemia
Metabolic acidosis
Fluid overload
Uraemic encephalopathy (high levels urea in the blood)

41
Q

How do we manage hyperkaelemia in people who have an AKI

A

restrict dietary potassium

treat insulin or salbutamol causing a shift of potassium from the blood stream into cells

Potassium persistently high, patietns may need to undergo urgent dialysis

42
Q

How do we manage acidosis

A

solution to neutralize the pH of the blood often IV sodium bicarbonate is given and often these patients are admitted to HDU / ITU

43
Q

how do we manage oedema in people who have an AKI

A

give a loop diuretic e.g. furosemide whic his often given IV at a high dose

monitor serum creatine as there is a risk of worsening pre renal aki through dehydration

not all patients will be responsive so if persistently fluid overloaded patient may need to go through dialysis

44
Q

how do we manage uraemic encephalopathy

A

undergo urgent renal replacement therapy (dialysis to remove the toxic urea from the blood

45
Q

what complications require dialysis

A

hyperkalaemia
oedema
uraemic encephalopathy

46
Q

what does nephrotoxic mean

A

Nephrotoxicity is one of the most common kidney problems and occurs when your body is exposed to a drug or toxin that causes damage to your kidneys. When kidney damage occurs, you are unable to rid your body of excess urine, and wastes.

47
Q

give some examples of nephrotoxic potential medicines

A 
ACEIs
ARBs
NSAIDs
Diuretics
Aminogylcosides
Iodinated contrast agents
48
Q

what is chronic kidney disease

A

abnormalities of kidney function or structure present for more than 3 months with implications for health

49
Q

what prompts can lead to taking the GFR

A

persistant microalbuminuria
persistent proteinuria
pesrsistant haematuria

Therapeutics (50 decks)

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