Acute Kidney Conditions

Question 1

how is AKI defined?

Answer 1

serum creatinine
1) increase of >25 micromol / l in 48 hours

2) rise of more than 50% in 7 days

3) urine output reduced <0.5ml/kg/hour in 6 hours

Question 2

Drugs that can precipitate an AKI?

Answer 2

NSAIDs, gentamicin, diuretics and ACE inhibitors

Question 3

pre renal causes of an AKI?

Answer 3

insufficient blood supply

> hypoperfusion

Dehydration
Shock (e.g., sepsis or acute blood loss)
Heart failure

Question 4

Renal causes?

Answer 4

intrinsic disease

Acute tubular necrosis
Glomerulonephritis
Acute interstitial nephritis
Haemolytic uraemic syndrome
Rhabdomyolysis

Question 5

post renal ?

Answer 5

Kidney stones

Tumours (e.g., retroperitoneal, bladder or prostate)

Strictures of the ureters or urethra

Benign prostatic hyperplasia

Question 6

ATN is necrosis of?

what colour casts?

reversible?

Answer 6

epithelial cells

muddy brown on urinalysis

yes - 3 weeks

Question 7

nephrotoxins causing ATN?

Answer 7

gentamicin
radiocontrast
cisplatin

Question 8

acute interstitial nephritis
immune reaction associated with

Answer 8

NSAIDs / abx

infections - ecoli /hiv

sarcoidosis or SLE

Question 9

acute interstitial nephritis

presents how?

Answer 9

AKI +

rash/ fever/flank pain / eosinophilia

Question 10

mx of AIN?

Answer 10

steroids can play a role

Question 11

how is HUS managed?

Answer 11

hospital admission
IV fluids
blood transfusion
haemodialysis

Question 12

how is HUS diagnosed?

Answer 12

Stool culture
shiga toxin
0157

Question 13

what is MAHA?

Answer 13

haemolysis of RBC due to small vessel pathology - thrombi shear the RBC

= AKI

Question 14

HUS feature

Answer 14

MAHA
AKI
thrombocytopenia

unwell
abdo pain
fever
bruising
haematuria

Question 15

what is Henoch schonlein purpura?

Answer 15

IgA vasculitis

systemic

skin, joints , bowels and kidneys

Question 16

Rhabdomyolysis

Answer 16

breakdown of muscle cells
> potassium
>phosphate
>myoglobin
> CK

Question 17

hyperkalaemia can cause?

Answer 17

cardiac arrhythmias and cardiac arrest

Question 18

Ix rhabdomyolysis?
most importane?

Answer 18

creatine kinase CK crucial diagnostic blood test

<150 U/L

1000-100000

Question 19

how long does CK remain elevated for?

Answer 19

1-3 days > gradually falls

Question 20

myoglobin gives what colour in urine?

Answer 20

ed-brown colour. A urine dipstick will be positive for blood.

Question 21

Ix in rhabdomyolysis

Answer 21

CK
u&e
ECGs

Question 22

Mx of rhabdomyolysis?

Answer 22

IV fluids to correct hypovolaemia

Question 23

severe hyperkalaemia?

Answer 23

> 6.5

Question 24

normal serum potassium?

Answer 24

3.5-5.3

Question 25

medication that can cause hyperkalaemia?

Answer 25

ACEi
mineralocorticoid receptor antagonist> spironolactone

ARBs
NSAIDS

Question 26

ECG changes in hyperkalaemia?

Answer 26

tall peaked t waves
flattened p waves
prolonged PR
broad QRS

Question 27

Mx of hyperkalaemia?

Answer 27

insulin and dextrose infusion and IV calcium gluconate

Question 28

use of insulin in hyperkalaemia?

Answer 28

drives potassium from extracellular > intracellular

Question 29

Dextrose infusion

Answer 29

required to prevent hypoglycaemia while on insulin

Question 30

what does calcium gluconate do?

Answer 30

stabilise cardiac muscle cells
> risk of arrhythmias