Podcast Beta
Questions and Answers
What is the normal range for serum sodium (Na) levels?
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?
7 days
The kidneys are involved in _____ balance, which is crucial for maintaining proper body fluid levels.
Signup and view all the answers
Match the following renal functions with their descriptions:
Signup and view all the answers
Which of the following symptoms is NOT typically associated with renal history?
Signup and view all the answers
Individuals with hypertension and diabetes mellitus are at an increased risk for acute kidney injury (AKI).
Signup and view all the answers
What are two common drugs that can increase the risk of kidney injury?
Signup and view all the answers
The initial assessment for AKI includes observations such as lying and standing ______.
Signup and view all the answers
Match the following symptoms to their corresponding systems:
Signup and view all the answers
Which of the following is NOT a clinical presentation of Acute Kidney Injury (AKI)?
Signup and view all the answers
Peripheral oedema is a possible cardiovascular symptom associated with AKI.
Signup and view all the answers
What does AKI stand for?
Signup and view all the answers
Breathlessness can be a symptom of _______ in AKI.
Signup and view all the answers
Which of the following is a complication that can arise from AKI?
Signup and view all the answers
Match the symptoms with their corresponding systems affected in AKI:
Signup and view all the answers
High potassium levels (high K+) are a metabolic abnormality associated with AKI.
Signup and view all the answers
List one pre-renal cause of Acute Kidney Injury.
Signup and view all the answers
Which of the following signs is associated with pre-renal causes of AKI?
Signup and view all the answers
Skin turgor and cool peripheries can be indicators of renal failure.
Signup and view all the answers
What is one of the key examinations to consider when assessing AKI?
Signup and view all the answers
The examination should assess general health as well as ______ status, system-specific conditions, and other relevant symptoms.
Signup and view all the answers
Match the following symptoms or signs with their associated indications:
Signup and view all the answers
Which of the following is NOT a method for investigating Acute Kidney Injury (AKI)?
Signup and view all the answers
Acute Kidney Injury (AKI) can only be diagnosed through blood tests.
Signup and view all the answers
What is the primary purpose of performing a renal biopsy?
Signup and view all the answers
The primary blood tests used to assess kidney function include Urea and ______.
Signup and view all the answers
Match the following investigations with their purpose:
Signup and view all the answers
Which complication should be checked if acidosis is suspected?
Signup and view all the answers
Pre-renal causes of AKI can be assessed through imaging methods.
Signup and view all the answers
Name one acute complication that can arise from kidney dysfunction.
Signup and view all the answers
Study Notes
###Â 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).
###Â 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
-
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.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
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.
