Kidney

Kidney Functions

The kidney filters waste and metabolites, regulates water and electrolytes, retains essential substances, excretes waste, maintains acid-base balance, and has endocrine functions.

Acute Kidney Injury (AKI)

An abrupt decrease in kidney function, which can lead to acute renal failure.

Symptoms of AKI

Include nausea, vomiting, peripheral edema, breathlessness, itching, pleural effusion, weakness, pericarditis, decreased consciousness, oliguria, and convulsions.

Causes of AKI

Classified into pre-renal (inadequate perfusion), renal (damage to kidney), and post-renal (obstruction of urinary outflow).

Pre-renal Causes

Often due to sepsis, hypotension, or hypovolemia affecting kidney perfusion.

Renal Causes

Damage from drugs like NSAIDs, which inhibit vasodilation and can block renal blood vessels.

Post-renal Causes

Obstruction from kidney stones or trauma leading to increased creatinine levels.

AKI Treatment Goals

Prevent further damage and facilitate recovery, primarily by addressing the underlying cause and providing fluids.

Chronic Kidney Disease (CKD)

A reduction in renal function or structural damage lasting over 3 months, associated with health implications.

AKI vs CKD

Both can present similar blood profiles; previous results may help differentiate them.

CKD Symptoms

May include anemia, hypertension, neuropathy, dizziness, breathlessness, and lethargy.

CKD Classifications

Based on eGFR, hematuria, proteinuria, and microalbuminuria.

Referral Criteria for CKD

Includes GFR less than 30 ml/min, suspected renal artery stenosis, and significant declines in GFR.

Secondary Care Goals for CKD

Manage and delay progression, optimize care, and plan for dialysis or transplantation when eGFR is low.

Long-term Consequences of CKD

Include hypertension, anemia, renal bone disease, cardiovascular disease, edema, pruritus, restless leg syndrome, nausea, and GI ulceration.

Management of CKD

Involves treating underlying causes, dietary changes, controlling cardiovascular risks, correcting anemia, and managing electrolyte levels.

Renal Prescribing Principles

Consider drug absorption, distribution, metabolism, excretion, and pharmacodynamic alterations in patients with kidney issues.

Drug Selection Criteria

Choose non-nephrotoxic drugs with a large therapeutic index, low adverse effects, and that do not require renal metabolism or excretion.

Drug Dosing Adjustments

May be necessary for patients with renal impairment, including decreased doses and increased intervals.

Monitoring Parameters

Essential for assessing drug efficacy and safety in patients with kidney disease.