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Renal Week 2 2017/18 > 7: Acute kidney injury > Flashcards

7: Acute kidney injury Flashcards

1
Q

What is the definition of AKI?

A

Abrupt (<48h):

increase in serum creatinine (>26.4)

increase in creatinine by 50%

reduction in urine output

one of the above

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2
Q

What needs to be done before you can diagnose a patient with AKI?

A

Attempt fluid resuscitation

Exclude obstruction

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3
Q

What are some pre-renal causes of AKI?

A

Hypovolaemia

Hypotensive (cardiogenic, septic, anaphylactic)

Certain drugs

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4
Q

What are the definitions of

a) normal urine output
b) oligouria?

A

a) 0.5ml/kg/hr
b) < 0.5ml/kg/hr

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5
Q

If patients are sick (e.g diarrhoea, vomiting), which drugs should they stop to prevent AKI?

A

Antihypertensives

e.g ACE inhibitors, ARBs, diuretics

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6
Q

What happens if pre-renal AKI isn’t treated?

A

Acute tubular necrosis

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7
Q

What commonly causes pre-renal AKI?

A

Hypovolaemia, hypotension due to

sepsis

dehydation

Also:

drugs

rhabdomyolysis

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8
Q

What are signs and symptoms of dehydration?

A

Hypovolaemia

Tachycardia

Low urine output

Low JVP

Cap refill > 2s

Oedema

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9
Q

How is pre-renal AKI treated?

A

Fluid challenge for hypovolaemia and hypotension

500ml 0.9% NaCl over and over until improvement

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10
Q

What are some

a) vascular
b) glomerular

causes of renal AKI?

A

a) Vasculitis, renovascular disease (renal artery stenosis)

b) Glomerulonephritis

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11
Q

Which drugs can cause nephritis?

A

Antibiotics

PPIs

Gold, pencillamine

methotrexate

gentamicin

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12
Q

What are the symptoms of AKI?

A

Constitutional - anorexia, weight loss, fatigue..

N&V

Itch

Fluid retention

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13
Q

Which infection commonly causes glomerulonephritis?

A

GAS

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14
Q

What types of GN are suggested by

a) sore throat in the past 2-3 weeks
b) rash
c) joint pain
d) haemoptysis?

A

a) Post-streptococcal glomerulonephritis

b) Vasculitic nephritis

c) Lupus nephritis

d) Goodpasture’s syndrome

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15
Q

Why can compartment syndrome cause AKI?

A

Rhabdomyolysis

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16
Q

What are some blood tests which should be done for those with AKI?

A

U&Es - particularly hyperkalaemia

FBC - for anaemia, prolonged clotting

17
Q

What’s a quick test which can be done to pick up proteinuria / haematuria?

A

Urinalysis

18
Q

What imaging is first line for looking at the kidney?

What can it pick up?

A

USS

Stones

19
Q

Which causes of AKI are associated with

a) ANA

b) ANCA

c) GBM antibody?

A

a) SLE (not really)

b) Small vessel vasculitis

c) Goodpasture’s syndrome

20
Q

What are signs of multiple myeloma on blood test?

A

Hypercalcaemia

Anaemia

21
Q

When would a renal biopsy be indicated?

A

Rapidly progressing GN

Positive antibodies for something

Don’t know what’s wrong

22
Q

Which scan is used to guide renal biopsies?

A

USS

23
Q

What are some signs of life-threatening AKI?

A

Hyperkaleamia

Resistant fluid overload (pulmonary oedema with no urination)

Severe metabolic acidosis

Severe uraemia

24
Q

What causes post-renal AKI?

A

Obstruction of urinary tract

25
Q

What problem is caused by an obstructed urinary tract?

A

Hydronephrosis

26
Q

How does hydronephrosis cause AKI?

A

Loss of kidney’s ability to concentrate urine

27
Q

What can cause obstruction of the urinary tract?

A

Renal calculi

Malignancy

Strictures

Prostate enlargement

28
Q

What is a life-threatening electrolyte imbalance caused by AKI?

A

Hyperkalaemia

29
Q

What causes death in hyperkalaemia?

A

Arrythmia

30
Q

What is the normal range of potassium concentrations in the body?

What level is hyperkalaemic?

What level is life-threatening?

A

3.5 - 5.0

Hyperkalaemia: >= 5.5

Life-threatening hyperkalaemia: >= 6.5

31
Q

How is hyperkalaemia assessed?

A

U&Es

ECG

Muscle weakness

32
Q

What are the ECG manifestations of hyperkalaemia?

A

Bradycardia

Tall, tented T waves

Prolonged PR interval

33
Q

What drug is given first to protect the myocardium in hyperkalaemia?

A

Calcium gluconate

34
Q

What is given to

a) protect the myocardium
b) move K+ into cells
c) correct metabolic acidosis
d) prevent K+ absorption in the bowel

in a patient with hyperkalaemia?

A

a) Calcium gluconate

b) IV insulin + dextrose (to prevent hypoglycaemia, INH salbutamol

c) Sodium bicarbonate

d) Calcium resonium

35
Q

If AKI is very severe and isn’t being controlled by drugs, how is it treated?

A

Haemodialysis

36
Q

In what situations would you put a patient with AKI on dialysis?

A

Severely hyperkalaemic

Severe metabolic acidosis

Severely fluid overloaded

Severely uraemic

Renal Week 2 2017/18 (11 decks)

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