Podcast
Questions and Answers
What is the normal range for serum sodium (Na) levels?
What is the normal range for serum sodium (Na) levels?
The eGFR value of 53 mL/min/1.73m2 indicates normal kidney function.
The eGFR value of 53 mL/min/1.73m2 indicates normal kidney function.
False
What is the ideal time frame for measuring baseline creatinine levels?
What is the ideal time frame for measuring baseline creatinine levels?
7 days
The kidneys are involved in _____ balance, which is crucial for maintaining proper body fluid levels.
The kidneys are involved in _____ balance, which is crucial for maintaining proper body fluid levels.
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Match the following renal functions with their descriptions:
Match the following renal functions with their descriptions:
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Which of the following symptoms is NOT typically associated with renal history?
Which of the following symptoms is NOT typically associated with renal history?
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Individuals with hypertension and diabetes mellitus are at an increased risk for acute kidney injury (AKI).
Individuals with hypertension and diabetes mellitus are at an increased risk for acute kidney injury (AKI).
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What are two common drugs that can increase the risk of kidney injury?
What are two common drugs that can increase the risk of kidney injury?
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The initial assessment for AKI includes observations such as lying and standing ______.
The initial assessment for AKI includes observations such as lying and standing ______.
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Match the following symptoms to their corresponding systems:
Match the following symptoms to their corresponding systems:
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Which of the following is NOT a clinical presentation of Acute Kidney Injury (AKI)?
Which of the following is NOT a clinical presentation of Acute Kidney Injury (AKI)?
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Peripheral oedema is a possible cardiovascular symptom associated with AKI.
Peripheral oedema is a possible cardiovascular symptom associated with AKI.
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What does AKI stand for?
What does AKI stand for?
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Breathlessness can be a symptom of _______ in AKI.
Breathlessness can be a symptom of _______ in AKI.
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Which of the following is a complication that can arise from AKI?
Which of the following is a complication that can arise from AKI?
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Match the symptoms with their corresponding systems affected in AKI:
Match the symptoms with their corresponding systems affected in AKI:
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High potassium levels (high K+) are a metabolic abnormality associated with AKI.
High potassium levels (high K+) are a metabolic abnormality associated with AKI.
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List one pre-renal cause of Acute Kidney Injury.
List one pre-renal cause of Acute Kidney Injury.
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Which of the following signs is associated with pre-renal causes of AKI?
Which of the following signs is associated with pre-renal causes of AKI?
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Skin turgor and cool peripheries can be indicators of renal failure.
Skin turgor and cool peripheries can be indicators of renal failure.
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What is one of the key examinations to consider when assessing AKI?
What is one of the key examinations to consider when assessing AKI?
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The examination should assess general health as well as ______ status, system-specific conditions, and other relevant symptoms.
The examination should assess general health as well as ______ status, system-specific conditions, and other relevant symptoms.
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Match the following symptoms or signs with their associated indications:
Match the following symptoms or signs with their associated indications:
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Which of the following is NOT a method for investigating Acute Kidney Injury (AKI)?
Which of the following is NOT a method for investigating Acute Kidney Injury (AKI)?
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Acute Kidney Injury (AKI) can only be diagnosed through blood tests.
Acute Kidney Injury (AKI) can only be diagnosed through blood tests.
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What is the primary purpose of performing a renal biopsy?
What is the primary purpose of performing a renal biopsy?
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The primary blood tests used to assess kidney function include Urea and ______.
The primary blood tests used to assess kidney function include Urea and ______.
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Match the following investigations with their purpose:
Match the following investigations with their purpose:
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Which complication should be checked if acidosis is suspected?
Which complication should be checked if acidosis is suspected?
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Pre-renal causes of AKI can be assessed through imaging methods.
Pre-renal causes of AKI can be assessed through imaging methods.
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Name one acute complication that can arise from kidney dysfunction.
Name one acute complication that can arise from kidney dysfunction.
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Study Notes
### Baseline Renal Function
- Sodium: 138 mmol/L, range 133-146 mmol/L
- Potassium: 4.7 mmol/L, range 3.5-5.3 mmol/L
- Urea: 11.3 mmol/L, range 2.5-7.8 mmol/L
- Creatinine: 82 mmol/L (ideally 7 days), range 59-104 mmol/L
- eGFR: 53 mL/min/1.73m2, >60 mL/min/ 1.73m2
Renal Functions
- Waste/toxin excretion:
- Controlling blood volume and water balance:
- Maintaining acid-base balance:
- Maintaining electrolyte balance:
- Drug excretion:
- Blood pressure control:
- Erythropoietin production: formation of red blood cells
- Vitamin D activation: bone mineral metabolism
Chronic Kidney Disease (CKD)
- Indicates long-term kidney damage, affecting kidney function.
Acute Renal Complications
- Uraemia (build-up of toxins)
- Metabolic acidosis
- High potassium levels: electrolyte abnormalities
- Pulmonary oedema
- Fluid overload
- Hypertensive emergencies
Renal Assessment and Treatment Overview
- History: Collect information about symptoms, causes, and consequences of acute kidney injury (AKI).
- Examination: Focus on general well-being, fluid status, and specific systematic assessments.
- Diagnosis: Identify causes and complications of AKI.
- Investigations: Utilize bedside assessments, blood tests, imaging studies, and specialist consultations.
- Management: Implement immediate and long-term care; consider both medical and surgical interventions; involve a multidisciplinary team (MDT).
### AKI: Clinical Presentations and Related Causes
- Cardiovascular: Breathlessness, peripheral oedema, palpitations, hypertension
- Respiratory: Breathlessness, haemoptysis
- Endocrine: Abnormal blood sugars, fatigue, weight gain/loss
- Metabolic: Acid-base abnormalities, abnormal electrolytes (high potassium levels)
- Neurology: Headache, seizures, stroke
- Rheumatology/Dermatology: Joint pain, pruritus (itching), rashes
- Gastrointestinal: Nausea, altered taste, reduced appetite
- Haematology: Anaemia
- Urology: Haematuria (blood in urine), urinary symptoms, abnormal urinalysis
- Care of the Elderly: Frailty
- Mental Health: Acute confusion/delirium, encephalopathy
AKI Causes in the History:
- Pre-renal factors
- Renal factors
- Post-renal/obstructive factors
Renal History:
- Presenting Complaint: Symptoms of AKI
- Past Medical History: Risk factors for AKI including history of CKD, hypertension, diabetes mellitus, heart failure, gout, prostate problems, renal stones, UTIs, cancer, immunocompromised status, systemic disease.
-
Drug History: Be thorough including over-the-counter medications, herbal remedies, supplements, recreational drugs, all with specific timescales.
- Relevant medications: NSAID, antihypertensives (ACEi, ARBs, diuretics), antibiotics, PPIs.
- Past Surgical History: Functional status, AKI, and relevant procedures.
- Social History: Relevant information to consider, such as hobbies, diet, and alcohol/tobacco use.
AKI Examination:
-
Initial Assessment: Use End-of-the-bed-o'meter for vital signs and A to E assessment (airway, breathing, circulation, disability, exposure).
- Observations: Lying/standing BP, NEWS (National Early Warning Score)
- Cardiovascular: Fluid status, peripheral stigmata (signs), perfusion, pulses, rubs, murmurs.
- Respiratory: Respiratory effort, signs of pulmonary oedema.
- Abdominal: Palpable bladder, ballotable kidneys, renal bruit (abnormal sound heard with a stethoscope).
- Urinalysis: Essential; examine urine for abnormalities.
- Fundoscopy: Examine the eyes for potential signs of kidney problems.
Further Examination Considerations:
- Evaluate for potential pre-renal causes:
- Examine fluid status (skin turgor, cool peripheries)
- Sepsis or hypoperfusion (shock)
- Evaluate for potential post-renal causes:
- Face, skin, rashes, joints
- Perform a bladder exam
Investigating the Cause of AKI:
-
Pre-renal:
- Poor oral intake, fluid loss, thirst
- Medications: Diuretics, ACEi
- Cardiovascular compromise: Low BP, reduced perfusion.
-
Post Renal:
- Older male patient
- History of lower urinary tract symptoms (LUTS)
- History of malignancy, especially pelvic tumours
- Palpable bladder
- Possible bladder scan
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If Cause is Unknown:
- Consider detailed history and medical review
- Perform urine dipstick (blood and protein)
- Systemic review for malaise, weight loss, ENT symptoms (epistaxis, conjunctivitis), MSK symptoms (myalgia, arthralgia, skin rashes), haemoptysis.
- Consider intrinsic renal disease.
AKI Investigations:
-
Bedside:
- Monitor urine output
- Consider venous blood gas (VBG) and electrocardiogram (ECG)
-
Blood Tests:
- Complete blood count (CBC) including haematinics (iron, folic acid, vitamin B12)
- Electrolytes (particularly potassium)
- Urea (BUN)
- Creatinine
- Acidosis (Bicarbonate levels)
- Bone profile (calcium, phosphate)
-
Imaging:
- Chest X-ray (CXR)
- Renal Ultrasound
- Kidney size, shape, and number
- Residual bladder volume after micturition (urination)
-
Specialty Investigations:
- Renal biopsy
AKI Investigation Considerations:
- Urine Dipstick and UACR: Helpful in assessing pre-renal, post-renal, or intrinsic renal causes.
- Pre-renal Causes: Electrolytes, especially potassium; monitor closely for signs of dehydration or decreased perfusion.
- Renal Causes: Nephritic screen (for diseases like glomerulonephritis), ANCA (anti-neutrophil cytoplasmic antibody) tests, inflammatory markers (C3, C4, CRP, ESR), and other specific antibody tests.
- Post-renal Causes: Prostate-specific antigen (PSA)
Understanding Urine Analysis Findings:
- Bland/Negative: suggests pre-renal, renovascular (related to blood vessels), myeloma, or TIN (tubular interstitial nephritis)
- Blood: Indicates potential bleeding from uroepithelial tract, UTI, or catheter.
- Proteinuria: May indicate diabetes mellitus or other conditions.
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Description
Test your knowledge on renal function, chronic kidney disease, and acute renal complications. This quiz covers key concepts including renal assessments, treatments, and the various roles of the kidneys in maintaining homeostasis. Ideal for students and professionals in healthcare fields.
