8 AKI

Question 1

How do we measure AKI severity?

Answer 1

Seurm Creatinine

Urine output

Question 2

What is normal urine output?

Answer 2

1 - 1.5L

Question 3

What medications put people at greater risk of AKI?

Answer 3

Diuretics
ACEi
NSAID
Gentamicin
Venomycin
Chemotherapy

Question 4

What are the different causes of AKI generally?

Answer 4

Pre-renal (perfusion failure)
renal (intrinsic disease)
Post-renal (blockage)

Question 5

Name 3 things causing perfusion failure

Answer 5

hypotension
hypovolaemia
renal artery occlusion

Question 6

Why does it take a great loss in blood pressure and volume to decrease urine production?

Answer 6

the autoregulatory range is very flat for the normal range

Question 7

What sort of drug would be used to inhibit Angiotensin I formation?

Answer 7

Renin inhibitors

Question 8

What sort of drug would be used to inhibit Angiotensin II formation?

Answer 8

ACE inhibitors

Question 9

What sort of drug would inhibit vascular smooth muscle control?

Answer 9

Angiotensin II receptor blockers

Question 10

What sort of drug would block aldosterone action?

Answer 10

mineralocorticoid receptor antagonist

Question 11

Name a type of NSAID

Why is it problematic for AKI?

Answer 11

prostocyclin

inhibits autoregulation

Question 12

What causes acute tubular necrosis?

Answer 12

perfusion failure

Question 13

How might you treat perfusion failure?

Answer 13

fluid volume replacement
blood pressure support (inotropic drugs)
restore arterial patency
stop RAS blockade
stop NSAID

Question 14

What might cause post-renal obstruction?

Answer 14

stones
benign prostate
tumour
fibrosis

Question 15

How would you treat post-renal obstruction?

Answer 15

bladder catheter
surgery (nephrostomy, tumour removal)
lithotripsy
dilation of strictures (if fibrotic)

Question 16

What tissues may be damaged in renal causes of AKI?

Answer 16

tubules
glomerulus
interstitium

Question 17

What systemic diseases may cause Renal AKI?

Answer 17

vasculitis
SLE
myeloma

Question 18

What is SLE?

Answer 18

Systemic Lupus Erythematosus

Question 19

Name 2 types of infection which might cause renal AKI?

Answer 19

HIV

Endocarditis

Question 20

What sort of allergic reaction might cause renal AKI?

Answer 20

acute interstitial nephritis

Question 21

What tissues does ANCA vasculitis normally target?

Answer 21

renal organs

airway

Question 22

What causes ANCA Vasculitis?

Answer 22

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

Question 23

What would the glomerulus look like in renal vaculitis?

Answer 23

more diffuse and distorted, with bits of ischaemia

Question 24

How might you treat inflammatory Renal Disease?

Answer 24

steroids
cyclophasphamide
Plasma exchange
Azathioprine / Mycophenolate

Question 25

What problem is there with Cyclophosphamide?

Answer 25

heavily suppresses the immune system

make men and women permanently infertile

Question 26

What are the risks of prescribing azathioprine or mycophenolates?

Answer 26

long term suppression of immune system, more at risk of cancer and infection

Question 27

What is the main cause of death in AKI?

Answer 27

infection, and not really the homeostatic effects