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2nd Year - Urinary Diseases > 3.1. Kidney Injury - Acute Kidney Injury > Flashcards

3.1. Kidney Injury - Acute Kidney Injury Flashcards

1
Q

What is Acute Renal Disease?

A

The Rapid loss of Glomerular Filtration and Tubular Function over hours-days.

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2
Q

What fraction of Hospital admissions are complicated by this?

A

1/7

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3
Q

What are risk factors for developing an Acute Kidney Injury?

A
  1. Age

2. Underlying predisposign conditions (e.g. Diabetes)

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4
Q

What are the 3 types of Renal Disease?

A
  1. Pre-Renal - Blood Flow to the Kidney (Common)
  2. Renal (Intrinsic) - Damage to the Kidney Parenchyma
  3. Post-Renal - Obstruction to the Urine Exit (Common)
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5
Q

What are causes of Pre-Renal Acute Kidney Injury?

A
  1. Sepsis - Major contributor (50% of cases of AKI)
  2. Hypotension / Renal Artery Occlusion
  3. Hypovolaemia / Shock
  4. Hepato-renal Syndrome (Liver Failure)
  5. Congestive Cardiac Failure
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6
Q

What are causes of Renal Acute Kidney Injury?

A
  1. Acute Tubular Injury
  2. Tubulointerstitial Injury
  3. Glomerulonephritis
  4. Myeloma
  5. Vasculitis
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7
Q

What are causes of Post-Renal Acute Kidney Injury

A
  1. Kidney Stones
  2. Intramural Obstruction
  3. Extramural Obstruction
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8
Q

What are some aetiologies of Hypovolaemia (causing Pre-Renal Acute Kidney Injury)?

A
  1. Haemorrhage
  2. Burns
  3. Diuretics
  4. Vomiting / Diarrhoea
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9
Q

What are some aetiologies of Acute Tubular Injury (causing Renal Acute Kidney Injury)?

A
  1. Ischemia
  2. Pre-Renal Acute Kidney Injury
  3. Nephrotoxins
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10
Q

What is a cause of Tubulointerstitial Injury (causing Renal Acute Kidney Injury)?

A

Acute Interstitial Nephritis

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11
Q

What are some aetiologies of Vasculitis (causing Renal Acute Kidney Injury)?

A
  1. Lupus

2. Anti-Neutrophil Cytoplasmic Antibodies (ANCA)

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12
Q

What are some aetiologies of Kidney Stones (causing Post-Renal Acute Kidney Injury)?

A
  1. Calculus
  2. Clot
  3. Sloughed Papilla
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13
Q

What are some aetiologies of Intramural Obstruction (causing Post-Renal Acute Kidney Injury)?

A
  1. Malignancy
  2. Ureteric Stricture
  3. Prostatic Disease
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14
Q

What are some aetiologies of Extramural Obstruction (causing Post-Renal Acute Kidney Injury)?

A
  1. Retroperitoneal Fibrosis

2. Malignancy

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15
Q

What are the 4 Stages in the course of Acute Kidney Injury?

A
  1. Preventative Stage
  2. Management Stage
  3. Complications
  4. Death
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16
Q

What is the Preventative Stage?

A

There is a Normal Kidney which may be exposed to increase risk of Kidney Disease

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17
Q

What is the Management Stage?

A

Damage has occurred to the Kidney resulting in a decreased Glomerular Filtration Rate.
Note - This can lead to Complications and Kidney Failure

18
Q

What is the Complications Stage?

A

These include the list of Complications which can occur due to the Acute Kidney Injury

19
Q

Why can Death Occur?

A

Due to the Kidney Failure, or the Complications associated with the damage to the Kidney

20
Q

When the Injury is initiated, what is it initiated by? And is the Acute Kidney Injury still preventable?

A 
The aetiology (e.g. Toxins / Ischemic Insult)
It is still potentially preventable as the Renal Parenchymal Injury will still need (and continue) to evolve
21
Q

When is the patient usually maximally oliguric?

A

During the management stage when established Parenchymal Injury has occurred

22
Q

Does the Kidney have the potential to regenerate?

A

Yes, resulting in a gradulal increase in urine output and decrease in serum creatinine

23
Q

What are the Clinical Features of Acute Kidney Injury?

A
  1. Rapid Loss of Glomerular Filtration
  2. Rapid Loss of Tubular Function
  3. Retention of Urea
  4. Retention of Creatinine
  5. Oliguria
24
Q

What investigations are necessary for Acute Kidney Injury?

A
  1. Detailed History / Examination
  2. Blood Tests
  3. Urinalysis (Urine Dipstick)
  4. Ultrasound Scan
  5. Renal Biopsy
25
Q

What is the purpose of a Detailed History / Examination?

A
  1. To identify the insult (i.e. Drug)

2. To observe the Fluid Status / Urinary Obstruction etc

26
Q

What Blood Tests will be Performed?

A
  1. Serum Creatinine
  2. Full Blood Count
  3. Urea and Electrolytes (Including Bicarbonate and Calcium)
  4. Liver Function Test (and Biochemistry)
  5. Coagulation Screen
  6. Arterial Blood Gas
  7. Serum Anti-Neutrophil Cytoplasmic Antibodies test
27
Q

What is the purpose of the Blood Tests?

A
  1. To assess renal function (serum creatinine)

2. To try to identify any other potential cause

28
Q

What is the purpose of the Urinalysis (Urine Dipstick)?

A

To identify Haematuria, and Proteinuria

29
Q

What is the purpose of the Ultrasound Scan?

A

To try and find any Post-Renal causes of Acute Kidney Injury

30
Q

What is the purpose of the Renal Biopsy?

A

To confirm the Diagnosis

31
Q

How many stages are there in the KDIGO (Kidney Disease; Improving Global Outcomes) classification?

A

3

32
Q

What is defined as a Stage 1, in the KDIGO (Kidney Disease; Improving Global Outcomes) classification, in terms of Creatinine / Urine Output?

A

Serum Creatinine:
a) 1.5 - 1.9 x the baseline
OR
b) Greater than 26.5 μmol/l increase

Urine Output:
Less than 0.5ml/kg/h for 6 - 12 hours

33
Q

What is defined as a Stage 2, in the KDIGO (Kidney Disease; Improving Global Outcomes) classification, in terms of Creatinine / Urine Output?

A

Serum Creatinine:
a) 2.0 - 2.9 x the baseline

Urine Output:
Less than 0.5ml/kg/h for more than 12 hours

34
Q

What is defined as a Stage 3, in the KDIGO (Kidney Disease; Improving Global Outcomes) classification, in terms of Creatinine / Urine Output?

A 
Serum Creatinine:
a) more than 3.0 x the baseline 
OR
b) An incraesed to 354μmol/l
OR
c) Initiation of Renal Replacement Therapy

Urine Output:
Less than 0.5ml/kg/h for 6 - 12 hours

35
Q

What are the Treatments of Acute Kidney Injury?

A
  1. Anticipation and Prevention of AKI
  2. Treat the Underlying Cause (e.g. stop nephrotoxic drugs)
  3. Specific Treatments
    a) Pre-Renal
    b) Renal
    c) Post-Renal
  4. Renal Replacement Therapy
36
Q

What is included in the Pre-Renal Specific Treatments?

A
  1. Fluid Balance - Volume Resuscitation / Fluid Restriction

2. Blood Pressure Support - Vasopressors / Stop Anti-Hypertensives

37
Q

What is included in the Renal Specific Treatments?

A

Removal of the Precipitant:

  1. Treat Sepsis
  2. Stop taking causative Drugs
  3. Diagnosis of Glomerulonephritis made
38
Q

What is included in the Post-Renal Specific Treatments?

A
  1. Haemodialysis - Solute removal by diffusion (intermittent therapy)
  2. Haemofiltration - Solute removal by convection (continuous therapy)
39
Q

What acronym does the overall treatment of Acute Kidney Injury follow? And what does it stand for?

A 
STOP:
Sepsis
Toxins
Optimize Blood Pressure
Prevent Harm
40
Q

What Complications fall under the “Prevent Harm” section of the “STOP” acronym for the management of Acute Kidney Injuries?

A 
A, E, I, O, U:
Acidosis
Electrolyte Imbalance (Hyperkalaemia)
Intoxication (Toxins - Use antidote / RRT)
Overload (Pulmonary Oedema)
Uraemic Complications (Pericarditis)

2nd Year - Urinary Diseases (16 decks)

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