Renal & Hepatic 00 / 23 , all cards and bookmarks
Staging acute kidney injury 02 / 23 Stage creatinine against baseline and weight-indexed urine output separately; the higher stage counts.
Kidney Disease: Improving Global Outcomes (KDIGO) stage by creatinine KDIGO stage by urine output Report a problem with card 2: Staging acute kidney injury
Child-Pugh class and surgical risk 03 / 23 Five markers score 1–3 points each; class C carries perioperative mortality up to about 80%.
Modified Child-Pugh score (Barash): five variables, 1 to 3 points each Child-Pugh class and perioperative mortality (Barash, Stoelting) Report a problem with card 3: Child-Pugh class and surgical risk
Procedures in kidney disease 04 / 23 In kidney disease, the procedure plan turns on shock, bleeding risk and the fistula arm.
The volatile in liver disease 05 / 23 In hepatitis or cirrhosis maintain with sevoflurane; never halothane, the immune-hepatitis volatile.
Which fluid, which drug, which renal support 06 / 23 Isotonic volume, never starch; mannitol before the clamp, though unproven; continuous support when unstable.
The kidney graft 07 / 23 Protect the graft from cold storage to closure: balanced fluid, diuretics before reperfusion, watch airway pressure.
Correcting low sodium 08 / 23 Salt-losing low sodium needs isotonic saline and salt, never fluid restriction; calculate rate from body water.
Metabolic alkalosis: cause and consequence 10 / 23 In vomiting, chloride loss drives the alkalosis, and the alkalosis drives potassium into cells.
The ECG and the electrolytes 12 / 23 Long QT, U waves or torsades point to low potassium, magnesium or calcium; never high potassium.
Syndrome of transurethral prostate resection (TURP syndrome) 13 / 23 Neurological or circulatory change during or after TURP or hysteroscopy: absorbed irrigant until sodium says otherwise.
The anhepatic phase and graft reperfusion 14 / 23 Expect the phase's chemistry: citrate drops ionised calcium; reperfusion brings potassium, acid and hypotension.
Late problems after surgery and feeding 15 / 23 Trace a late postoperative change to what was given or stopped: feeding or the anaesthetic.
Renal blood flow, volume and the tubule 16 / 23 Flow autoregulates over a pressure range; atrial stretch sheds volume; each substance has its tubular site.
Who gets acute kidney injury 17 / 23 Kidney injury risk rises with chronic kidney disease (CKD), heart failure and emergency surgery.
Risk factors for kidney injury Setting Risk factors Any surgery, in both books → , open its explanation Older age, heart failure, CKD, liver disease Noncardiac surgery adds → , open its explanation Male sex, hypertension, ascites, emergency, intraperitoneal surgery Contrast nephropathy → , open its explanation Pre‑existing kidney disease strongest; diabetes, hypertension, gout lesser
Outcome after ruptured aneurysm repair Report a problem with card 17: Who gets acute kidney injury
Tumour lysis syndrome 19 / 23 Tumour lysis releases potassium, phosphate and urate; calcium falls; dehydration raises the risk.
Cirrhosis: circulation, lungs, portal pressure 20 / 23 Cirrhosis dilates vessels and raises portal pressure: high output, low resistance, lung complications, shunts for varices.
The hyperdynamic circulation Hypoxaemia: two lung syndromes Death in liver disease Transjugular intrahepatic portosystemic shunt (TIPS): use or avoid Report a problem with card 20: Cirrhosis: circulation, lungs, portal pressure
Transplant listing and aftercare 21 / 23 Liver candidates rank by the allocation rules; after transplantation expect the drug's chemistry and typical complications.
Liver allocation in children: Paediatric End-stage Liver Disease (PELD) score Electrolytes after transplantation Right-lobe living-donor liver transplant Report a problem with card 21: Transplant listing and aftercare
Associations 22 / 23 Each condition has its tell-tale finding: cola urine in rhabdomyolysis, high calcium in sarcoidosis.
Traps Check these before you finish 1 card · about 1 min 23 Traps
Traps 23 / 23 The tempting call is the louder sign or the familiar fix; the books name another.
Tempting Right call Dilute urine as the prerenal sign → , open its explanation Prerenal: osmolality >400, sodium ≤20, FENa <1% Hypovolaemia for oliguria persisting after volume restored → , open its explanation Acute tubular necrosis, not simple hypovolaemia Adult‑sounding hourly urine as no injury → , open its explanation Index to weight; worse criterion sets KDIGO stage Low CVP in citrate hypotension → , open its explanation Citrate toxicity: CVP and LVEDP raised, narrow pulse pressure Diabetes insipidus for falling sodium after pituitary surgery → , open its explanation Cerebral salt wasting: saline, salt; hypertonic if symptomatic; never restrict Hypochloraemia as result of metabolic alkalosis → , open its explanation Hypokalaemia is the consequence; low chloride is a cause Hyperkalaemia for torsades or long QT → , open its explanation Low magnesium, potassium or calcium; give magnesium Isoflurane as the best volatile in hepatitis → , open its explanation Sevoflurane first; never halothane Low mixed venous saturation in cirrhosis → , open its explanation High mixed venous saturation, high output, low SVR Hypokalaemia with ciclosporin‑type immunosuppression → , open its explanation Low magnesium; potassium rises, not falls Hypokalaemia in tumour lysis syndrome → , open its explanation Hypocalcaemia; potassium, phosphate and urate rise Fentanyl as the predictably prolonged drug → , open its explanation Neostigmine; atracurium and cisatracurium unchanged Ulnar after failed radial in kidney failure → , open its explanation Femoral; keep arm arteries for future fistulas Concentrated albumin as most nephrotoxic fluid → , open its explanation Hydroxyethyl starch, in sepsis; albumin is not nephrotoxic Bleeding for hypotension, confusion after glycine TURP → , open its explanation Absorbed irrigant: low sodium and osmolality
Report a problem with card 23: Traps
Quiz Check yourself 22 practice scenarios · one to a screen Quiz Check yourself 22 practice scenarios Answers checked against the books and guidelines.
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Sheet 11 · Renal & Hepatic 23 / 23
That is Renal & Hepatic, all 23 cards.
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Back to the sheets The 23 rules One rule per card, in the sheet's order. Tap one to open its card.
Part 1 · Decisions What to do
04 · Procedures in kidney disease In kidney disease, the procedure plan turns on shock, bleeding risk and the fistula arm. 05 · The volatile in liver disease In hepatitis or cirrhosis maintain with sevoflurane; never halothane, the immune-hepatitis volatile. 06 · Which fluid, which drug, which renal support Isotonic volume, never starch; mannitol before the clamp, though unproven; continuous support when unstable. 07 · The kidney graft Protect the graft from cold storage to closure: balanced fluid, diuretics before reperfusion, watch airway pressure. 08 · Correcting low sodium Salt-losing low sodium needs isotonic saline and salt, never fluid restriction; calculate rate from body water. Part 4 · Conditions and mechanisms Why it is true
16 · Renal blood flow, volume and the tubule Flow autoregulates over a pressure range; atrial stretch sheds volume; each substance has its tubular site. 17 · Who gets acute kidney injury Kidney injury risk rises with chronic kidney disease (CKD), heart failure and emergency surgery. 18 · End-stage renal disease and dialysis Kidney failure retains what the kidney clears; dialysis removes solutes and water, not chronic damage. 19 · Tumour lysis syndrome Tumour lysis releases potassium, phosphate and urate; calcium falls; dehydration raises the risk. 20 · Cirrhosis: circulation, lungs, portal pressure Cirrhosis dilates vessels and raises portal pressure: high output, low resistance, lung complications, shunts for varices. 21 · Transplant listing and aftercare Liver candidates rank by the allocation rules; after transplantation expect the drug's chemistry and typical complications. 22 · Associations Each condition has its tell-tale finding: cola urine in rhabdomyolysis, high calcium in sarcoidosis.