Acute Kidney Disease

Question 1

What is the definition of AKD?

Answer 1

Rapid loss of glomerular filtration & tubular function over hours to days

Question 2

In AKD, what measure of GFR will be used?

Answer 2

serum Creatinine (raised)

Question 3

Why is creatinine on its own not the best measure of GFR?

Answer 3

Late marker (great loss of kidney function before mirrored in creatinine)

Question 4

The definition of AKD states that an increase of serum creatinine by ____ within _____ hours.

Answer 4

26mmol

48 hours

Question 5

What are the different stages of AKI?

Answer 5

AKI 1-3
1: urine output <0.5 6-12 hrs
2: <0.5 >12hrs
3 <0.3 for >24 hrs or anuria (12rs)

Question 6

What are the immediately dangerous consequences of AKI?

Answer 6

Acidosis
Electrolyte imbalance
Intoxification TOXINS
Overload
Uraemia complications

Question 7

The definition of AKD states urine volume is less than _____ ml/kg/h for _____ hours.

Answer 7

0.5

6 hours

Question 8

What are some of the pre-renal causes of AKI?

Answer 8

Anything which causes hypo perfusion of kidneys:

Cardiac failure
Haemorrhage
Sepsis
Vomiting & diarrhoea

Question 9

What are some of the renal (Intrinsic) cause of AKI?

Answer 9

Anything which has caused damage to kidneys:

Glomerulonephritis
Vasculitis
Radiocontrast
Myeloma
Drugs (NSAIDs & gentamicin)

Question 10

What are some of the post-renal causes of AKI?

Answer 10

Anything which obstructs urine exit

Tumours
Prostate disease
Stones

Question 11

What is the most common cause of AKI?

Answer 11

Hypoperfusion of kidney (pre-renal)

Question 12

What is myeloma?

Answer 12

Haematological malignancy where proliferation of plasma cells produces an excess Igs

Question 13

What are some of the signs & symptoms of myeloma?

Answer 13

Anaemia 
Back pain
Weight loss
Farctures
Infections 
Hypercalaemia

Question 14

What is the term used for kidney disease associated with myeloma?

Answer 14

Cast nephropathy

Question 15

What are some of the risk factors associated with AKI presentation?

Answer 15

Sepsis 
Hypotension 
Hypovolaemia 
Surgery 
Heart failure 
Diabetes mellitus
Toxins (NSAIDs & genticimin, radiocontrast)

Question 16

What should be avoided if AKI is suspected?

Answer 16

Nephrotoxic agents

Dehydration

Question 17

What does the STOP acronym stand for in AKI management?

Answer 17

Sepsis
Toxins
Optimise BP
Prevent harm

Question 18

What investigations may you consider if suspecting AKI?

Answer 18

Creatinine
U&Es
FBC
USS
Blood gas
Urinalysis (protein, blood)
Renal biopsy

Question 19

What allows you to assess fluid status of patient?

Answer 19

Fluid volume chart

Question 20

In AKI, what can be observed on ECG? What is this caused by?

Answer 20

Tented T waves

Hyperkalaemia - can lead to cardiac arrest

Question 21

In AKI, why can some patients die from cardiac arrest?

Answer 21

Elevated K levels results in hyerkalaemia which can cause arrhythmias

Question 22

What are some of the treatment methods for hyerpkalaemia?

Answer 22

Calcium gluconate (stabilises myocardium)
Insulin-dextrose (moves K intracellularly)

Dialysis
Diuresis

Question 23

Which drugs can reach toxic levels in AKI patients?

Answer 23

Morphine 
Digoxin
Aspirin 
Lithium 
Metformin