Acute Kidney Conditions Flashcards
how is AKI defined?
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
Drugs that can precipitate an AKI?
NSAIDs, gentamicin, diuretics and ACE inhibitors
pre renal causes of an AKI?
insufficient blood supply
> hypoperfusion
Dehydration
Shock (e.g., sepsis or acute blood loss)
Heart failure
Renal causes?
intrinsic disease
Acute tubular necrosis
Glomerulonephritis
Acute interstitial nephritis
Haemolytic uraemic syndrome
Rhabdomyolysis
post renal ?
Kidney stones
Tumours (e.g., retroperitoneal, bladder or prostate)
Strictures of the ureters or urethra
Benign prostatic hyperplasia
ATN is necrosis of?
what colour casts?
reversible?
epithelial cells
muddy brown on urinalysis
yes - 3 weeks
nephrotoxins causing ATN?
gentamicin
radiocontrast
cisplatin
acute interstitial nephritis
immune reaction associated with
NSAIDs / abx
infections - ecoli /hiv
sarcoidosis or SLE
acute interstitial nephritis
presents how?
AKI +
rash/ fever/flank pain / eosinophilia
mx of AIN?
steroids can play a role
how is HUS managed?
hospital admission
IV fluids
blood transfusion
haemodialysis
how is HUS diagnosed?
Stool culture
shiga toxin
0157
what is MAHA?
haemolysis of RBC due to small vessel pathology - thrombi shear the RBC
= AKI
HUS feature
MAHA
AKI
thrombocytopenia
unwell
abdo pain
fever
bruising
haematuria
what is Henoch schonlein purpura?
IgA vasculitis
systemic
skin, joints , bowels and kidneys
Rhabdomyolysis
breakdown of muscle cells
> potassium
>phosphate
>myoglobin
> CK
hyperkalaemia can cause?
cardiac arrhythmias and cardiac arrest
Ix rhabdomyolysis?
most importane?
creatine kinase CK crucial diagnostic blood test
<150 U/L
1000-100000
how long does CK remain elevated for?
1-3 days > gradually falls
myoglobin gives what colour in urine?
ed-brown colour. A urine dipstick will be positive for blood.
Ix in rhabdomyolysis
CK
u&e
ECGs
Mx of rhabdomyolysis?
IV fluids to correct hypovolaemia
severe hyperkalaemia?
> 6.5
normal serum potassium?
3.5-5.3
medication that can cause hyperkalaemia?
ACEi
mineralocorticoid receptor antagonist> spironolactone
ARBs
NSAIDS
ECG changes in hyperkalaemia?
tall peaked t waves
flattened p waves
prolonged PR
broad QRS
Mx of hyperkalaemia?
insulin and dextrose infusion and IV calcium gluconate
use of insulin in hyperkalaemia?
drives potassium from extracellular > intracellular
Dextrose infusion
required to prevent hypoglycaemia while on insulin
what does calcium gluconate do?
stabilise cardiac muscle cells
> risk of arrhythmias
