Renal

ben.ramsay
Flashcards by ben.ramsay, updated more than 1 year ago
ben.ramsay
Created by ben.ramsay over 6 years ago
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Renal flashcards

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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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