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Renal > 4.7: Acute Kidney Injury > Flashcards

4.7: Acute Kidney Injury Flashcards

1
Q

What is the definition of acute kidney injury?

A

An abrupt (<48hours) in kidney function and

  • Absolute increase in serum creatinine by >26.4umol/l
  • OR Increase by creatinine by 50%
  • OR Reduction in urinary output
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2
Q

Describe the staging for AKI?

A

Stage 1 = Increase in 1.5-1.9 x reference creatinine

Stage 2 = Increase in 2-2.9 x reference creatinine

Stage 3 = Increase of 3 x reference creatinine or need for dialysis

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3
Q

Acute kidney injury is a …

Not a ..?

A

Acute kidney injury is a DESCRIPTION, not a DIAGNOSIS

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4
Q

Causes of AKI can be divided into three groups. What are they?

A

Pre-Renal (Reduced blood flow)

Renal (Intrinsic Renal Causes)

Post-Renal (Obstructive)

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5
Q

Describe pre-renal causes of AKI?

A

Anything that causes hypovolaemia

  • Bleeding
  • Diarrhoea or vomiting
  • Burns
  • Dehydration
  • MI
  • NSAIDs
  • ACE Inhibitors and ARBs
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6
Q

Describe pre-renal AKI?

A

Reversible

Rise in creatinine, decrease in urine output

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7
Q

Value for normal urine output?

Value for oliguria?

A

Normal - 0.5ml/kg/hour

Oliguria - <0.5ml/kg/hour

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8
Q

Explain the pathophysiology of pre-renal AKI?

A

Volume depletion for whatever cause

Decreased intravascular volume

RAAS activated

Increased adolsterone and angiotensin

Salt and water retention

Oliguria

AKI

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9
Q

How much of the cardiac output does the kidneys recieve?

A

20%

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10
Q

Untreated renal AKI leads to what?

A

Tubular Necrosis

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11
Q

Describe acute tubular necrosis?

A

Commonest form of acute AKI in hospital

Caused by reduced renal perfusion - eg: Dehydration, sepsis, rhabdomyolisis and drug toxicity

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12
Q

Treatment of pre-renal AKI?

A
  • Check hydration
  • Fluid challenge for hypovolaemia

Either 0.9% NaCl or Colloid

DO NOT USE 5% DEXTROSE

Give fluid bolus and reasses

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13
Q

Causes of Renal AKI?

A
  • Vasculitis
  • Glomerulonephritis
  • Interstitial Nephritis
  • Tubular Injury (Ischaemia, Drugs Eg: Gentamicin, Contrast, Rhabdomyolysis)
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14
Q

Signs and symptoms of AKI?

A

Non specific

Anorexia, weight loss, fatigue

Nausea and vomiting

Itch

Fluid overload (Oedema, SOB)

Oliguria

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15
Q

Investigations of AKI?

A

Urinalysis

U&Es

FBC and Coagulation Screen

Ultrasound

Protein Electrophoresis

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16
Q

When would you carry out a renal biopsy in AKI?

A

If you suspect rapidly progressive glomerulonephritis

Positive immunology

Unexplained AKI

17
Q

Describe further treatment of AKI (once hydration levels are sorted?)

A

Establish Good Perfusion Pressure (Continue Fluid Resus)

Treat underlying cause (Antibiotics if septic)

Stop Nephrotoxics

Dialysis

18
Q

Describe some life threatening complications of AKI?

A

Pulmonary Oedema

Hyperkalaemia

Severe Acidosis

Uraemic Pericardial Effusion

Severe Uraemia

19
Q

What causes post renal AKI?

A

Obstruction

  • Stones
  • Cancers
  • Strictures
  • External Pressures
20
Q

Treatment of post renal AKI?

A

Relieve obstruction

  • Catheter
  • Nephrostomy (Like a catheter but goes through skin)
21
Q

What are the normal potassium values?

What are the hyperkalaemia values?

Life threatening hyperkalaemia value?

A

3.5-5.0

Hyperkalaemia >5.0

Life threatening >6.5

22
Q

ECG changes in hyperkalaemia?

A

Tented T Waves

23
Q

Medical treatment of hyperkalaemia?

A

ECG

IV Access

10mls 10% Calcium Gluconate

Insulin + Glucose (50%, 50mls)

Salbutamol

24
Q

Name some urgent indications for dialysis?

A

Hyperkalaemia >6.5

Severe Acidosis (pH <7.15)

Fluid Overload

Urea >40, pericardial rub/effusion

25
Q

Question:

40 year old male presents with general malaise and haemoptysis

  • Urea 28
  • Creatinine 200
  • Elevated anti-GBM
A

Goodpastures Syndrome

26
Q

25 year old IVDA drug user found collapsed at home?

A

Rhabdomyolosis

27
Q

82 year old man addmited with hypertension, Temp 39, Pulse 140, Potassium 7, Urea 48, Creatinine 789, CRP 250

CXR Left basal consolidation

A

Acute Tubular Necrosis

28
Q

72 year old man presenting with difficulty passing urine and reduced urine output?

A

Obstructive Uropathy

29
Q

Which of these drugs don’t cause hyperkalaemia?

A

Furosemide

30
Q
A

Calcium Gluconate

31
Q
A

D - Elevated Creatinine

32
Q

Risk factors for AKI?

A

Diabetes

Age

Co-morbidities - Heart failure, liver failure

33
Q

Most common cause of AKI?

A

Pre-renal

Sepsis, Hypotension, Hypovolaemia, Dehydration

Renal (34 decks)

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