Acute Kidney Disease Flashcards
What is the definition of AKD?
Rapid loss of glomerular filtration & tubular function over hours to days
In AKD, what measure of GFR will be used?
serum Creatinine (raised)
Why is creatinine on its own not the best measure of GFR?
Late marker (great loss of kidney function before mirrored in creatinine)
The definition of AKD states that an increase of serum creatinine by ____ within _____ hours.
26mmol
48 hours
What are the different stages of AKI?
AKI 1-3
1: urine output <0.5 6-12 hrs
2: <0.5 >12hrs
3 <0.3 for >24 hrs or anuria (12rs)
What are the immediately dangerous consequences of AKI?
Acidosis Electrolyte imbalance Intoxification TOXINS Overload Uraemia complications
The definition of AKD states urine volume is less than _____ ml/kg/h for _____ hours.
0.5
6 hours
What are some of the pre-renal causes of AKI?
Anything which causes hypo perfusion of kidneys:
Cardiac failure
Haemorrhage
Sepsis
Vomiting & diarrhoea
What are some of the renal (Intrinsic) cause of AKI?
Anything which has caused damage to kidneys:
Glomerulonephritis Vasculitis Radiocontrast Myeloma Drugs (NSAIDs & gentamicin)
What are some of the post-renal causes of AKI?
Anything which obstructs urine exit
Tumours
Prostate disease
Stones
What is the most common cause of AKI?
Hypoperfusion of kidney (pre-renal)
What is myeloma?
Haematological malignancy where proliferation of plasma cells produces an excess Igs
What are some of the signs & symptoms of myeloma?
Anaemia Back pain Weight loss Farctures Infections Hypercalaemia
What is the term used for kidney disease associated with myeloma?
Cast nephropathy
What are some of the risk factors associated with AKI presentation?
Sepsis Hypotension Hypovolaemia Surgery Heart failure Diabetes mellitus Toxins (NSAIDs & genticimin, radiocontrast)
What should be avoided if AKI is suspected?
Nephrotoxic agents
Dehydration
What does the STOP acronym stand for in AKI management?
Sepsis
Toxins
Optimise BP
Prevent harm
What investigations may you consider if suspecting AKI?
Creatinine U&Es FBC USS Blood gas Urinalysis (protein, blood) Renal biopsy
What allows you to assess fluid status of patient?
Fluid volume chart
In AKI, what can be observed on ECG? What is this caused by?
Tented T waves
Hyperkalaemia - can lead to cardiac arrest
In AKI, why can some patients die from cardiac arrest?
Elevated K levels results in hyerkalaemia which can cause arrhythmias
What are some of the treatment methods for hyerpkalaemia?
Calcium gluconate (stabilises myocardium) Insulin-dextrose (moves K intracellularly)
Dialysis
Diuresis
Which drugs can reach toxic levels in AKI patients?
Morphine Digoxin Aspirin Lithium Metformin
