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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
Q

How is pericarditis associated with AKIs?

A

It can develop as a result of uraemia complications

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26
Q

How is encephalopathy associated with AKIs?

A

It can develop as a result of uraemia complications

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27
Q

What are the five investigations used to diagnose an AKI?

A

Urine dipstick test

Blood tests

Ultrasound scan

ECG scan

Renal biopsy

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28
Q

What six urine dipstick test results indicate acute kidney injury?

A

Haematuria

Proteinuria

Positive Leukocytes

Positive Nitrites

Positive Glucose

Positive Urine Bence Jones Protein

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29
Q

What is haematuria on a urine dipstick test?

A

It is defined as a dipstick positive result of 1+ blood

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30
Q

What is the most important investigation used to diagnose acute kidney injury?

A

Urine Dipstick

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31
Q

What cause of acute kidney injury is indicated by the presence of haematuria on a urine dipstick test?

A

Acute nephritis

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32
Q

What is proteinuria on a urine dipstick test?

A

It is the presence of more than 1.5g of protein in urine per day

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33
Q

What cause of acute kidney injury is indicated by the presence of proteinuria on a urine dipstick test?

A

Acute nephritis

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34
Q

What cause of acute kidney injury is indicated by the presence of leukocytes on a urine dipstick test?

A

Infection

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35
Q

What cause of acute kidney injury is indicated by the presence of nitrites on a urine dipstick test?

A

Infection

36
Q

What cause of acute kidney injury is indicated by the presence of glucose on a urine dipstick test?

A

Diabetes mellitus

37
Q

What cause of acute kidney injury is indicated by the presence of urine bence jones protein on a urine dipstick test?

A

Multiple myeloma

38
Q

What six blood test results indicate acute kidney injury?

A

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
Q

What is an eGFR?

A

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
Q

How do we calculate eGFR?

A

We measure the patient’s serum creatinine levels and apply it in estimating equations

41
Q

What eGFR estimating equation is most commonly used in clinical practice?

A

MDRD 4 variable equation

42
Q

What blood test result is used to differentiate between AKIs and CKDs?

A

Calcium

AKI = Increased

CKD = Decreased

43
Q

What are AKI e-alerts?

A

An algorithm built into the laboratory system, which identifies patients with AKI due to their blood results

44
Q

How is an ultrasound used to diagnose an AKI?

A

It is used to identify obstructive, post-renal causes of acute kidney injury

45
Q

When are ultrasound scans recommended to investigate AKIs?

A

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
Q

What is the key investigation used to distinguish between AKI and CKD?

A

Ultrasound scan

47
Q

What is a feature of chronic kidney disease on ultrasound scans - allowing differentiation between acute kidney injury?

A

Bilateral small kidneys

48
Q

In which four circumstances can ultrasound scans not be used to differentiate between AKIs and CKDs?

A

Autosomal dominant polycystic kidney disease

Diabetic nephropathy

Amyloidosis

HIV-associated nephropathy

49
Q

How are ECG scans used to investigate AKIs?

A

It can be used to identify complication development of hyperkalaemia

50
Q

What are the three features of hyperkalaemia on ECG scans?

A

Tall T Waves

Diminished P Waves

Widened QRS Complexes

51
Q

What is a renal biopsy?

A

It involves using a special needle to extract small pieces of kidney tissue for light and electron microscopic examination

52
Q

How is a renal biopsy used to diagnose an AKI?

A

It is used to identify renal causes of acute kidney injury

53
Q

What are two preventative measures of an AKI?

A

STOP AKI Prevention

Medicine Sick Day Rules

54
Q

What is STOP AKI prevention?

A

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
Q

What are five AKI risk events?

A

Sepsis

Toxins

Surgery

Hypotension

Hypovolaemia

56
Q

When is the STOP AKI prevention initiated?

A

In cases where patients are undergoing a risk event and have one or more risk factors

57
Q

What does STOP AKI prevention stand for?

A

Sepsis

Toxins

Optimise Blood Pressure & Volume Status

Prevent Harm

58
Q

What does the S in the STOP AKI prevention include? What does this involve?

A

Sepsis

We screen for and treat sepsis appropriately

59
Q

What does T in the STOP AKI prevention include? What does this involve?

A

Toxins

We avoid prescribing patients nephrotoxic drugs

60
Q

What does O in the STOP AKI prevention include? What does this involve?

A

Optimise blood pressure and volume status

Hypovolaemia = IV fluids

Hypotension = withhold antihypertensive agents

61
Q

What does P in the AKI STOP prevention stand for? What does this involve?

A

Prevent harm

Daily U&Es

Managing fluid balance

62
Q

What are medicine sick day rules?

A

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
Q

What pneumonic is used to manage AKIs?

A

SHOUT

Sepsis

Hypovolaemia

Obstruction

Urinalysis

Toxins

64
Q

What does S in the SHOUT AKI management stand for? What does this involve?

A

Sepsis

We treat sepsis as per the local guidance

65
Q

What AKI cause classification is associated with hypovolaemia?

A

Pre-renal causes

66
Q

What does H in the SHOUT AKI management stand for? What does this involve?

A

Hypovolaemia

Assess volume status

Commence fluid balance charts

Consider fluid resuscitation with IV fluids

Consider the insertion of a urinary catheter

67
Q

What does O in the SHOUT AKI management stand for? What does this involve?

A

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
Q

What does U in the SHOUT AKI management stand for?

A

Urinalysis

69
Q

What does T in the SHOUT AKI management stand for? What does this involve?

A

Toxins

We stop nephrotoxic drugs

70
Q

Which five drugs should be stopped in AKI as they may worsen renal function?

A

NSAIDs

ACE inhibitors

ARBs

Diuretics

Aminoglycosides

71
Q

Which NSAID can still be continued in AKIs? At what dose?

A

Aspirin

75mg once daily

72
Q

Which three drugs may have to be stopped in AKI as increased risk of toxicity - however doesn’t usually worsen AKI itself?

A

Metformin

Lithium

Digoxin

73
Q

In which six circumstances, do we need to escalate acute kidney injury patients to urologists?

A

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
Q

What are the five complications of an AKI?

A

AEIOU

metabolic Acidosis

Electrolyte imbalance

drug Intoxication

pulmonary Oedema

Uraemic complications

75
Q

Which two electrolyte imbalances can result from acute kidney injuries?

A

Hyperkalaemia

Hyperphosphatemia

76
Q

What is the definition of hyperkalaemia?

A

> 5.1mmol/l

77
Q

At what potassium level do cardiac complications arise?

A

> 6.5mmol/

78
Q

What two investigations can be used to diagnose hyperkalaemia?

A

Blood tests

ECG scan

79
Q

What are the six management options used in hyperkalaemia?

A

IV Calcium Gluconate

Nebulised Salbutamol

Insulin-Dextrose Infusion

Oral/Enema Calcium Resonium

Loop Diuretics

Dialysis

80
Q

How does IV calcium gluconate treat hyperkalaemia?

A

It stabilises the cardiac membrane

81
Q

How does nebulised salbutamol treat hyperkalaemia?

A

It causes an intracellular shift of potassium

82
Q

How does insulin-dextrose infusion treat hyperkalaemia?

A

It causes an intracellular shift of potassium

83
Q

How does calcium resonium treat hyperkalaemia?

A

It removes potassium from the body

84
Q

How does loop diuretics treat hyperkalaemia?

A

It removes potassium from the body

85
Q

How does dialysis treat hyperkalaemia?

A

It removes potassium from the body

86
Q

What are two uraemic complications of acute kidney injury?

A

Pericarditis

Encephalopathy

Year Two - Urinary System (15 decks)

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