8 AKI Flashcards
How do we measure AKI severity?
Seurm Creatinine
Urine output
What is normal urine output?
1 - 1.5L
What medications put people at greater risk of AKI?
Diuretics ACEi NSAID Gentamicin Venomycin Chemotherapy
What are the different causes of AKI generally?
Pre-renal (perfusion failure)
renal (intrinsic disease)
Post-renal (blockage)
Name 3 things causing perfusion failure
hypotension
hypovolaemia
renal artery occlusion
Why does it take a great loss in blood pressure and volume to decrease urine production?
the autoregulatory range is very flat for the normal range
What sort of drug would be used to inhibit Angiotensin I formation?
Renin inhibitors
What sort of drug would be used to inhibit Angiotensin II formation?
ACE inhibitors
What sort of drug would inhibit vascular smooth muscle control?
Angiotensin II receptor blockers
What sort of drug would block aldosterone action?
mineralocorticoid receptor antagonist
Name a type of NSAID
Why is it problematic for AKI?
prostocyclin
inhibits autoregulation
What causes acute tubular necrosis?
perfusion failure
How might you treat perfusion failure?
fluid volume replacement blood pressure support (inotropic drugs) restore arterial patency stop RAS blockade stop NSAID
What might cause post-renal obstruction?
stones
benign prostate
tumour
fibrosis
How would you treat post-renal obstruction?
bladder catheter
surgery (nephrostomy, tumour removal)
lithotripsy
dilation of strictures (if fibrotic)
What tissues may be damaged in renal causes of AKI?
tubules
glomerulus
interstitium
What systemic diseases may cause Renal AKI?
vasculitis
SLE
myeloma
What is SLE?
Systemic Lupus Erythematosus
Name 2 types of infection which might cause renal AKI?
HIV
Endocarditis
What sort of allergic reaction might cause renal AKI?
acute interstitial nephritis
What tissues does ANCA vasculitis normally target?
renal organs
airway
What causes ANCA Vasculitis?
anti-neutrophil cytoplasm antibodies make neutrophils behave is if there were an infection, damaging surrounding tissues and diverting their attention away from actual infections and cancers
What would the glomerulus look like in renal vaculitis?
more diffuse and distorted, with bits of ischaemia
How might you treat inflammatory Renal Disease?
steroids
cyclophasphamide
Plasma exchange
Azathioprine / Mycophenolate
What problem is there with Cyclophosphamide?
heavily suppresses the immune system
make men and women permanently infertile
What are the risks of prescribing azathioprine or mycophenolates?
long term suppression of immune system, more at risk of cancer and infection
What is the main cause of death in AKI?
infection, and not really the homeostatic effects
