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Year Two - Urinary System > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

What is another term for acute kidney injury?

A

Acute kidney failure

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2
Q

What is an acute kidney injury?

A

It is defined as an acute drop in kidney function over a period of days to weeks

This reduction in kidney function tends to be reversible

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3
Q

Define AKI stage one

A

Serum Creatinine - >26.5µmol/L (0.3mg/dl) increase or 1-1.9 times baseline within 48 hours OR > 50% increase in 7 days

Urine Output - <0.5mk/kg/hr for 6-12 hours

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4
Q

Is a diagnosis of AKI indicated when serum creatinine levels increase greater than 26µmol/l, however still remain within the ‘normal’ range?

A

Yes

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5
Q

What is the diagnostic criteria of stage one AKI in children and young adults?

A

EGFR reduction > 25%

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6
Q

Define AKI stage two

A

Serum Creatinine - 2.0-2.9 times baseline

Urine Output - <0.5mk/kg/hr for >12 hours

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7
Q

Define AKI stage three

A

Serum Creatinine - > 354 µmol/L increase or 3 times baseline

Urine Output - <0.3mk/kg/hr for >24 hours or anuria for > 12 hours

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8
Q

How do we define an AKI prolonged over a period greater than three months?

A

End-stage kidney disease

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9
Q

What are the seven risk factors of AKI?

A

Older Age > 65 Years Old

Chronic Kidney Disease

Diabetes Mellitus

Heart Failure

Liver Disease

Nephrotoxic Drugs

Emergency Surgery

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10
Q

Which twelve nephrotoxic drugs are associated with acute kidney injury?

A

ACE inhibitors

ARBs

Potassium Sparing Diuretics

NSAIDs

Metformin

Digoxin

Lithium

Methotrexate

Gentamicin

Co-Trixamazole

Trimethoprim

Iodinated Contrast

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11
Q

In AKI patients, how to we prevent risk of contrast induced kidney injury?

A

We offer IV hydration before and after contrast infusion

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12
Q

What are the three classifications of acute kidney injury causes?

A

Pre-renal

Renal

Post-renal

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13
Q

What category of AKI causes is most common?

A

Pre-renal

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14
Q

How do pre-renal causes lead to an AKI?

A

There is an inadequate blood supply (hypoperfusion) to the kidney, thus reducing the filtration of blood

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15
Q

What are the five pre-renal causes of an AKI?

A

Heart Failure

Cardiogenic Shock

Renal Artery Stenosis

Hypovolaemia

Haemorrhage

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16
Q

In most cases what is hypovolaemia related to?

A

Vomiting

Diarrhoea

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17
Q

What feature of AKIs indicate a pre-renal cause?

A

A good response to fluid challenge

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18
Q

How do renal causes lead to an AKI?

A

The intrinsic kidney diseases, which cause damage to the glomeruli, renal tubules or interstitium of the kidneys themselves, thus reducing filtration of blood

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19
Q

What are the seven renal causes of an AKI?

A

Glomerulonephritis

Acute Tubular Necrosis

Acute Interstitial Nephritis

Rhabdomyolysis

Tumour Lysis Syndrome

Multiple Myeloma

Nephrotoxic Drugs

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20
Q

How do post-renal causes lead to an AKI?

A

An obstruction of urine flow from the kidney causes back-pressure into the kidney and therefore reduced kidney function

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21
Q

What are the five post-renal causes of an AKI?

A

Unilateral Renal Calculi

Benign Prostate Hyperplasia

Colon Cancer

Prostate Cancer

Cervical Cancer

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22
Q

What are the eight clinical features associated with AKIs?

A

Oliguria

Peripheral Oedema

Pulmonary Oedema

Arrythmias

Pericarditis Features

Encephalopathy Features

Hypertension

Increased JVP

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23
Q

What is oliguiria?

A

It is defined as a decreased urine output < 0.5ml/kg/hr

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24
Q

How are arrhythmias associated with AKIs?

A

They can develop secondary to potassium changes

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25
How is pericarditis associated with AKIs?
It can develop as a result of uraemia complications
26
How is encephalopathy associated with AKIs?
It can develop as a result of uraemia complications
27
What are the five investigations used to diagnose an AKI?
Urine dipstick test Blood tests Ultrasound scan ECG scan Renal biopsy
28
What six urine dipstick test results indicate acute kidney injury?
Haematuria Proteinuria Positive Leukocytes Positive Nitrites Positive Glucose Positive Urine Bence Jones Protein
29
What is haematuria on a urine dipstick test?
It is defined as a dipstick positive result of 1+ blood
30
What is the most important investigation used to diagnose acute kidney injury?
Urine Dipstick
31
What cause of acute kidney injury is indicated by the presence of haematuria on a urine dipstick test?
Acute nephritis
32
What is proteinuria on a urine dipstick test?
It is the presence of more than 1.5g of protein in urine per day
33
What cause of acute kidney injury is indicated by the presence of proteinuria on a urine dipstick test?
Acute nephritis
34
What cause of acute kidney injury is indicated by the presence of leukocytes on a urine dipstick test?
Infection
35
What cause of acute kidney injury is indicated by the presence of nitrites on a urine dipstick test?
Infection
36
What cause of acute kidney injury is indicated by the presence of glucose on a urine dipstick test?
Diabetes mellitus
37
What cause of acute kidney injury is indicated by the presence of urine bence jones protein on a urine dipstick test?
Multiple myeloma
38
What six blood test results indicate acute kidney injury?
Decreased eGFR Level > 25% in 7 Days Increased Creatinine Level > 26umol (0.3mg/dl) In 48hrs OR 50% In 7 Days Increased Urea Level Increased Calcium Level Increased Potassium Level Decreased Bicarbonate Level
39
What is an eGFR?
The estimated glomerular filtration rate and is the amount of blood passing through the glomeruli each minute It therefore measures the kidney’s function in filtering blood
40
How do we calculate eGFR?
We measure the patient’s serum creatinine levels and apply it in estimating equations
41
What eGFR estimating equation is most commonly used in clinical practice?
MDRD 4 variable equation
42
What blood test result is used to differentiate between AKIs and CKDs?
Calcium AKI = Increased CKD = Decreased
43
What are AKI e-alerts?
An algorithm built into the laboratory system, which identifies patients with AKI due to their blood results
44
How is an ultrasound used to diagnose an AKI?
It is used to identify obstructive, post-renal causes of acute kidney injury
45
When are ultrasound scans recommended to investigate AKIs?
This should be conducted within 24 hours of assessment in cases where there is no identifiable cause for deterioration or individuals are at risk of urinary tract infection.
46
What is the key investigation used to distinguish between AKI and CKD?
Ultrasound scan
47
What is a feature of chronic kidney disease on ultrasound scans - allowing differentiation between acute kidney injury?
Bilateral small kidneys
48
In which four circumstances can ultrasound scans not be used to differentiate between AKIs and CKDs?
Autosomal dominant polycystic kidney disease Diabetic nephropathy Amyloidosis HIV-associated nephropathy
49
How are ECG scans used to investigate AKIs?
It can be used to identify complication development of hyperkalaemia
50
What are the three features of hyperkalaemia on ECG scans?
Tall T Waves Diminished P Waves Widened QRS Complexes
51
What is a renal biopsy?
It involves using a special needle to extract small pieces of kidney tissue for light and electron microscopic examination
52
How is a renal biopsy used to diagnose an AKI?
It is used to identify renal causes of acute kidney injury
53
What are two preventative measures of an AKI?
STOP AKI Prevention Medicine Sick Day Rules
54
What is STOP AKI prevention?
It involves identifying any hospitalised patients at an increased risk of acute kidney injury We do this by determining if they are undergoing any AKI risk events and have any AKI risk factors
55
What are five AKI risk events?
Sepsis Toxins Surgery Hypotension Hypovolaemia
56
When is the STOP AKI prevention initiated?
In cases where patients are undergoing a risk event and have one or more risk factors
57
What does STOP AKI prevention stand for?
Sepsis Toxins Optimise Blood Pressure & Volume Status Prevent Harm
58
What does the S in the STOP AKI prevention include? What does this involve?
Sepsis We screen for and treat sepsis appropriately
59
What does T in the STOP AKI prevention include? What does this involve?
Toxins We avoid prescribing patients nephrotoxic drugs
60
What does O in the STOP AKI prevention include? What does this involve?
Optimise blood pressure and volume status Hypovolaemia = IV fluids Hypotension = withhold antihypertensive agents
61
What does P in the AKI STOP prevention stand for? What does this involve?
Prevent harm Daily U&Es Managing fluid balance
62
What are medicine sick day rules?
In cases where patients are prescribed multiple nephrotoxic drugs, we give them medicine sick day rules This means that when these patients suffer from severe vomiting, severe diarrhoea, fevers or sweats, they are advised to stop specific medications until they feel well again
63
What pneumonic is used to manage AKIs?
SHOUT Sepsis Hypovolaemia Obstruction Urinalysis Toxins
64
What does S in the SHOUT AKI management stand for? What does this involve?
Sepsis We treat sepsis as per the local guidance
65
What AKI cause classification is associated with hypovolaemia?
Pre-renal causes
66
What does H in the SHOUT AKI management stand for? What does this involve?
Hypovolaemia Assess volume status Commence fluid balance charts Consider fluid resuscitation with IV fluids Consider the insertion of a urinary catheter
67
What does O in the SHOUT AKI management stand for? What does this involve?
Obstruction A bladder scan and/or ultrasound scan to identify urinary tract obstructions In cases where an obstruction is identified, we must resolve it
68
What does U in the SHOUT AKI management stand for?
Urinalysis
69
What does T in the SHOUT AKI management stand for? What does this involve?
Toxins We stop nephrotoxic drugs
70
Which five drugs should be stopped in AKI as they may worsen renal function?
NSAIDs ACE inhibitors ARBs Diuretics Aminoglycosides
71
Which NSAID can still be continued in AKIs? At what dose?
Aspirin 75mg once daily
72
Which three drugs may have to be stopped in AKI as increased risk of toxicity - however doesn't usually worsen AKI itself?
Metformin Lithium Digoxin
73
In which six circumstances, do we need to escalate acute kidney injury patients to urologists?
Acute Kidney Injury Stage Three Chronic Kidney Injury Stage Four & Five Unidentifiable Cause of Acute Kidney Injury Post-Renal Acute Kidney Injury Causes Inadequate Treatment Response Complication Development
74
What are the five complications of an AKI?
AEIOU metabolic Acidosis Electrolyte imbalance drug Intoxication pulmonary Oedema Uraemic complications
75
Which two electrolyte imbalances can result from acute kidney injuries?
Hyperkalaemia Hyperphosphatemia
76
What is the definition of hyperkalaemia?
> 5.1mmol/l
77
At what potassium level do cardiac complications arise?
> 6.5mmol/
78
What two investigations can be used to diagnose hyperkalaemia?
Blood tests ECG scan
79
What are the six management options used in hyperkalaemia?
IV Calcium Gluconate Nebulised Salbutamol Insulin-Dextrose Infusion Oral/Enema Calcium Resonium Loop Diuretics Dialysis
80
How does IV calcium gluconate treat hyperkalaemia?
It stabilises the cardiac membrane
81
How does nebulised salbutamol treat hyperkalaemia?
It causes an intracellular shift of potassium
82
How does insulin-dextrose infusion treat hyperkalaemia?
It causes an intracellular shift of potassium
83
How does calcium resonium treat hyperkalaemia?
It removes potassium from the body
84
How does loop diuretics treat hyperkalaemia?
It removes potassium from the body
85
How does dialysis treat hyperkalaemia?
It removes potassium from the body
86
What are two uraemic complications of acute kidney injury?
Pericarditis Encephalopathy

Year Two - Urinary System (15 decks)

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