Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

OSCEazy Slide template 2021-2022 We look forward to your teaching session! • At OSCEazy, we have been renowned for our colourful slide templates and a very clear slide structure that presents information systematically • In this slide set there are slides for introductions, content, pictures, summaries...you can use as many or as few of these slides as you need by deleting/duplicating the template slides you want • We always advice to use a variety of different slide structures to keep your session engaging and interesting to look at! • You can add/replace content/pictures/textboxes to these slides as needed and delete any sections (such as this slide) as required **PLEASE DO NOT SHARE THIS SLIDE TEMPLATE OR USE THIS TEMPLATE FOR USES OTHER THAN YOUR TEACHING SESSION** • We would be very grateful to hear your feedback on our slide template. Please fill in this form once you have made your slides: https://docs.google.com/forms/d/e/1FAIpQLSdfFpHXn3QtY05WvPCqD_lq28lZoYnBRuk3jqCu8ORVKhSgAg/viewf orm?usp=sf_linkPreclineazy TobyKidney injury and acute presentations GFR homeostasis in health Urea : Creatinine ratio Causes of AKI Hyperkalemia Hypocalcemia and Kidney injury Anion Gap acidosis Ultrafiltration Normal GFR is 125 ml/minute GFR is the rate of filtration through the kidney Afferent arteriole Efferent arteriole High GFR if 1) Afferent arteriole dilated Efferent arteriole constricted 2) Blood pressure increased Low GFR if 1)Afferent arteriole constricted 2) Damage to glomerulus Hormonal changes to GFR GFR increased Afferent arteriole Efferent arteriole Dilate afferent arteriole Constricts efferent arteriole • Prostaglandins • Angiotensin II NSAIDS prevent this decreasing GFR Therefore ACE-I and angiotensin II • ANP receptor blockers decrease GFR Released when atria are stretched. This helps the heart cope as increasing Angiotensin also increases GFR can decrease blood volume systemic blood pressure increasing GFR If GFR is too high useful substances will Changes to blood pressure not be reabsorbed Increased Blood pressure Afferent arteriole Efferent arteriole High blood pressure stretches the afferent arteriole increasing GFR - Vessel wall contractsrinponse to bring GFR back down maintaining homeostasis GFR too high Juxtaglomerular When GFR is high lots of Na+ Apparartus will be filtered into tubule. This Na+ detected by macula densa cells(in juxtaglomerular apparatus) - Less renin released (to decrease BP) - Adenosine release (to constrict afferent arteriole) GFR too low Too little Na+ filtered. Macula densa cells detect low Na+ - Renin release is increased (increasing BP) Causes of AKI Urea : Creatine ratio AKI causes Renal Post Renal Pre Renal Toxicity e.g. drugs Dehydration/ Hypovolaemia Acute tubular necrosis (from prolonged Ureteric or bladder Renal artery stenosis hypoperfusion) obstruction Glomerular disease e.g. stones, tumours Fall in cardiac output e.g. sepsis, cardiac failure Small vessel disease Enlarged prostate Urea creatinine ratio Urea Creatinine Creatinine is filtered freely 50% of filtered urea is reabsorbed in the proximal convoluted tubule (PCT) and not reabsorbed Urea Creatinine Ratio Cause High (lots reabsorbed) normal High Pre-renal Low (little reabsorbed) High/normal Low Renal or post renalLow blood pressure causes ADH release drawing Urea and creatinine back into blood If there is damage to the kidney (renal cause) then less urea will be reabsorbed • GI blead – (Haemoglobin breakdown releases urea) • High protein diet Other causes of high urea • Dehydration (increasing concentration) High urea (>7mmol/l) can cause syndrome of uraemia (mental impairment, anorexia, nausea)Hyperkalaemia • Low GFR causes less K+ to be filtered • ACE-I or K+ sparing diuretics can cause AKI, Also increase K+ blood concentration Hyperkalaemia in AKI • Metabolic acidosis can occur due to organic acids building up in blood. This draw K+ out of cells High K+ (>5.2mmol/l) can cause life threatening arrythmiasHypocalcaemia 25-OH-cholecalciferol Cholecalciferol (vitamin D3) Calcitriol causes more Ca2+ absorption from Calcitriol (1-25-Di-OH-cholecalciferol) bone and the intestine • Convulsions • Arrythmias e.g. torsades de pointes Hypocalcaemia can cause CATS • Tetany (involuntary muscle contraction) • Spasms and abnormal SensationABGs ABGs Metabolic acidosis Respiratoryacidosis with full metabolic compensation Metabolic compensation occurs when the kidney produces bicarbonate. This process takes 3-5 days https://geekymedics.com/abg-interpretation/ Metabolic Acidosis and the Anion Gap NAGMA (hyperchloremic metabolic AGMA acidosis) Ureterosigmoidostomy M Methanol (Cl- exchanged for H–O in bowel) U Uraemia Saline infusion D DKA Early renal failure (decreased HCO3- P Propylene glycol / paracetamol production) Diarrhoea I Infection L Lactate Carbonic anhydrase E Ethylene Glycol inhibitors Salicylates (acutely causes S Addison's diseases respiratory alkalosis) Renaltubular acidosis Supplements (TPN) O•heLactates • Ketonic acids • Toxindegradation products • Other organic acids2e.g. H PO4 Na+ x HCO 3- x (somepeopleinclude K+) - Cl Other Anions • Lactate • Ketonic acids Anion GAP = • Toxindegradation products Na -(Cl +HCO3 ) - • Other acids e.g.2H PO4 Normal is <12 Na+ HCO3 (somepeopleinclude K+) - Cl O•heLactates • Ketonic acids • Toxindegradation products • Other organic acids2e.g. H PO4 Na+ x HCO 3- x (somepeopleinclude K+) - Cl Q U E S T I 1 N Low Na+ detected causing A adenosine release A woman is in hypovolaemic shock causing B Low Na+ detected causing renin release renal hypoperfusion. Macula densa cells detect low pressure Which of the following is true of the C causing smooth muscle contraction juxtaglomerular apparatus? D High pressure detected causing renin release Low pressure detected causing adenosine E release ANSWER ON THE ZOOM POLLA woman is in hypovolaemic shock causing renal hypoperfusion. Which of the following is true of the juxtaglomerular apparatus? Low Na+ = low GFR. Adenosine constricts afferent A Low Na+ detected causing arteriole lowering GFR further adenosine release Low Na+ = low GFR. Renin raises blood pressure B Low Na+ detected causing renin release which dilates afferent arteriole to increase GFR Macula densa cells have no roll in pressure Macula densa cells detect low pressure C causing smooth muscle contraction Macula densa cells have no roll in pressure D High pressure detected causing renin release Macula densa cells have no roll in pressure E Low pressure detected causing adenosine release ANSWER ON THE ZOOM POLL Q U E S T I2O N A Anaemia A man was diagnosed with stage 4 renal B Hypokalaemia failure one year ago. Recently he has been feeling tired and a blood C Hypophosphatemia test is taken. D High Iron levels Which of these are the most likely result ? E Low Urea ANSWER ON THE ZOOM POLLA man was diagnosed with stage 4 renal failure one year ago. Recently he has been feeling tired a blood test is taken. Which of these are the most likely result. ? The kidney is responsible for producing EPO which stimulates A Anaemia red blood cell production HypERkalaemiais more likely due to metabolic acidosis, drawing K+ out of cells, and failure to filtrate B Hypokalaemia HypERphosphatemiais more likely due to failure to filter into C Hypophosphatemia the nephron Low iron levels are more likely due to the kidney not clearing D hepcidin, the hormone which inhibits iron absorption High Iron levels Less urea will be filtered leading high urea. E Low Urea ANSWER ON THE ZOOM POLL Q U E S T I 1 N Renal tubular acidosis A A man is seen to have an anion gap metabolic B Metformin overdose acidosis. Which of the following is a caus e? C TPN D Addisons Saline infusion E ANSWER ON THE ZOOM POLL Q U E S T I 1 N Renal tubular acidosis A A man is seen to have a anion gap metabolic B Metformin overdose acidosis. Which of the following is a caus e? TPN C Metformin causes increased lactate. D Addisons All others are NAGMA causes Saline infusion E ANSWER ON THE ZOOM POLL PLEASE FILL OUT THE FEEDBACK FORM PLEASE TUNE IN TO OUR REMAINING SESSIONS THIS WEEK! @OSCEazyOfficial @osceazyofficial OSCEazy Osceazy@gmail.com