[5] Acute Kidney Injury Flashcards
What is acute kidney injury defined as?
An abrupt deterioration in parenchymal renal function, which is usually but not always reversible over a period of days or weeks
Why can AKI be a medical emergency?
It can cause sudden, life-threatening biochemical disturbances
How is AKI usually recognised?
By reduced urine output and raising serum urea and creatinine
What are the risk factors for AKI?
- Pre-existing CKD
- Age
- Male gender
- Co-morbidities
What co-morbidities increase the risk of AKI?
- Diabetes
- CVD
- Malignancy
- Chronic liver disease
What are the common causes of AKI?
- Sepsis
- Major surgery
- Cardiogenic shock
- Other hypovolaemia
- Drugs
- Hepatorenal syndrome
- Obstruction
What are the categories of causes of AKI?
- Pre-renal
- Renal
- Post-renal
What happens in pre-renal AKI?
There is decreased perfusion of kidneys
What is the pathology in renal AKI?
Intrinsic renal disease
What happens in post-renal AKI?
Obstruction of urine
What are the causes of pre-renal AKI?
- Hypovolaemia
- Decreased cardiac output
- Hypotension without hypovolaemia
- Renal vasoconstriction
What can cause hypovolaemia?
- Dehydration
- Haemorrhage
- D&V
- Burns
- Pancreatitis
What can cause decreased cardiac output?
- Cardiogenic shock
- MI
What can cause hypotension without hypovolaemia?
- Cirrhosis
- Shock
What can cause renal vasoconstriction?
- NSAIDs
- ACE inhibitors
- Hepatorenal syndrome
What are the renal causes of AKI?
- Glomerular disease
- Interstitial disease
- Vessel disease
What can cause glomerular disease?
- Glomerulonephritis
- Acute tubular necrosis
What can cause interstitial renal disease?
- Drug reactions
- Infection
- Infiltration
What can cause vessel disease in the kidneys?
- Vasculitis
- Haemolytic uraemic syndrome
- Thrombotic thrombocytopenic purpura
- Disseminated intravascular coagulation
What % of renal parenchymal AKIs are due to acute tubular necrosis?
80-90%
What will lead to ischaemic ATN?
Almost any cause of AKI< if prolonged to a point where renal autoregulation fails