1378278
Description
Flashcards by ben.ramsay, updated more than 1 year ago
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Created by ben.ramsay
over 9 years ago
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| Question | Answer |
| 5 factors that differentiate chronic from acute renal injury | 1) Renal anaemia (normocytic) 2) Elevated Phosphate 3) Hypertension 4) Reduced kidney size on ultrasound 5) Clinical risk factors (HTN, Diabetes, etc) |
| 3 major causes of AKI in the hospital inpatient setting | 1) Sepsis 2) Major surgery (esp cardiac, aortic) 3) Acute heart failure |
| List of Nephrotoxic drugs (ABC's) (6 As, 1 B, 3 C's) | A - Aminoglycosides, ACEI/ARB, Aciclovir, Anti-inflammatories (NSAIDS), Amphotericin, anti-folate (MTX) B - Beta-lactams C - Calcineurin inhibitors, Cisplatin, Contrast |
| General management principles for patient presenting with AKI (5) | 1) Address electrolytes and acidosis 2) Address fluid overload with diuretics (correlation between fluid overload and poor outcomes) 3) Nutritional support 4) Consider dialysis triggers 5) Stress ulcer prophylaxis/ DVT prophylaxis |
| Causes of AKI in the patient with cirrhosis (6) | 1) Sepsis 2) Diuretic induced hypovolaemia 3) Paracentesis-induced hypovolaemia 4) Lactulose-induced hypovolaemia 5) Cardiomyopathy 6) hepatorenal syndrome |
| Steps of management in Rhabdomyolysis (4) | 1) Fluid resuscitate 2) Address compartment syndrome 3) Urine alkalinisation (target pH <6.5) 4) Maintain polyuria (target > 300mls/hr) |
| What is the criteria to stop CRRT in the critically ill patient? | Spontaneous UO of >500mls/24 hours (ATN and RENAL trials) |
| What is the target CRRT dose in the critically ill patient with AKI? | 25mls/kg/hr (ATN and RENAL trials show the higher doses are no more effective) |
| Non-renal causes of an increased urea | 1) GI Bleeding 2) Tissue breakdown 3) Catabolic state (eg sepsis) 4) Reduced anabolism (eg. on corticosteroids) 5) Low muscle mass eg chronically ill, frail elderly |
| What is a normal Ur:Cr ratio | 40 - 60 when both expressed in mmol/L (creatinine usually expressed in umol/L so just put a decimal point in front of it to get it to mmol/L) |
| What are three causes of a Ur:Cr ratio elevation above 80? | 1) Pre-renal AKI 2) Non-renal increases in urea (see other flash card) 3) Decreases in creatinine (low muscle mass eg. frail elderly, prolonged malnutrition) |
| What are two causes of a decreased Urea (and hence underestimating Ur:Cr) | 1) Reduced protein synthesis (Liver failure) 2) Reduced protein intake |
| Fractional excretion of Urea <35% supports a diagnosis of pre-renal or intrarenal AKI? | Prerenal Urea excretion drops with renal vasoconstriction |
| Fractional excretion of Sodium of <1% supports a diagnosis of prerenal or intrarenal AKI | prerenal Renal vasoconstriction causes reduction in sodium excretion Cant be used in the presence of diuretics, glycosuria, or mannitol. All of which decrease sodium reabsobtion i.e: increase FENa |
| What value of urine sodium suggests volume depletion | <20mol/L |
| What value of urine osmolarity suggests volume depletion? | > 500mmol/kg |
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