5. Acute Kidney Injury

Question 1

What is acute kidney injury (AKI)?

Answer 1

Rapid reduction in kidney function.
↑ creatinine
↓ urine output

Question 2

What factor(s) determine a patients AKI stage?
urine output
proteinuria
ketonuria
serum creatinine
glycosuria

Answer 2

Serum Creatinine

Urine output

Question 3

Which of these is incorrect?
AKI is associated with:
↑ mortality
↑ length of stay
↑ risk of chronic kidney disease
↓ morbidity
↑ cost

Answer 3

↓ morbidity

Question 4

Which has a greater risk of death?
Myocardial infarction
Breast cancer
AKI stage III
Prostate cancer
Heart failure
Diabetes

Answer 4

AKI Stage III

higher risk of dying that all of these COMBINED

Question 5

Kidney stones are classed as ‘intrinsic AKI’.

True or False?

Answer 5

FALSE

Post-renal AKI

Question 6

Sepsis and hypotension are classed as ‘pre-renal AKI’.

True or False?

Answer 6

TRUE

Question 7

Acute tubular injury stemming from sepsis and hypotension is classed as ‘pre-renal AKI’.
True or False?

Answer 7

FALSE
intrinsic AKI

Intrinsic AKI is cellular damage i.e. lack of blood caused by a prolonged pre-renal AKI.

Question 8

Should you be worried about a hypovolemic patient post-surgery who is vomiting and is on diuretics?

Answer 8

Yes. Risk of AKI.

Typical clinical presentation:

1. acutely ill / post surgery
2. poor fluid intake
3. excessive fluid loss

Question 9

Which of these is not a complication of AKI?

Hyperkalaemia
Hypokalaemia
Acidaemia
Pulmonary oedema
Deep vein thrombosis
Uraemia
Anaemia
Nausea

Answer 9

Deep Vein Thrombosis

Hypokalaemia

Question 10

How can AKI be investigated?

Give 4 examples.

Answer 10

1. Full blood count
2. U+Es (urea + electrolytes) and bicarbonate
3. C-reactive protein
4. Liver function test
5. Calcium + phosphate
6. Creatine kinase
7. Urinalysis

Question 11

Serum creatinine levels are outside of the upper limit of normal at 50% kidney function.
True or False?

Answer 11

FALSE

You can lose 50% kidney function before serum creatinine levels rise above the upper limit of normal.

Question 12

What drugs are removed by the kidneys which need to be monitored in AKI?

Answer 12

Penicillin
Digoxin
Metformin
Opioids

Question 13

What is intermittent RRT (renal replacement therapy)?

Answer 13

Haemodialysis + peritoneal dialysis.

Used in patients who are haemodynamically stable.

Question 14

What is continuous RRT (renal replacement therapy)?

Answer 14

Continuous haemodialysis.

Constantly on it all the time.
Used in patients who are haemodynamically unstable.