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R - Urinary System (Liam Lennox) > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

What does AKI stand for?

A

Acute kidney injury

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2
Q

What is the definition of acute kidney injury?

A

Increase in SCreatinine:

  • By 26.5umol/L or more within 48 hours or
  • To 1.5x baseline, which is known or presumed to have occurred within the 7 prior days or
  • Urine volume <0.5ml/kg/h for 6 hours
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3
Q

What many stages of acute kidney injury are there?

A

3

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4
Q

What is the serum creatinine and urine output for AKI stage 1?

A
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5
Q

What is the serum creatinine and urine output for AKI stage 2?

A
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6
Q

What is the serum creatinine and urine output for AKI stage 3?

A
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7
Q

What does the immediately dangerous consequences of AKI depend on?

A

The immediately dangerous consequences of AKI depend on cause to an extent at least in the first few hours:

  • Acidosis
  • Electrolyte imbalance
  • Intoxication toxins
  • Overload
  • Uraemic complications
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8
Q

What can the causes of AKI be classified into?

A

Pre-renal

Intrinsic (renal)

Post-renal

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9
Q

What are the normal functions of the kidneys?

A

Body fluid homeostasis

Regulation of vascular tone

Excretory function

Electrolyte homeostasis

Acid/base homeostasis

Endocrine function

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10
Q

What are possible bad short term and intermediate/long term complications of AKI?

A
  • Short term (in hospital)
    • Death, dialysis, length of stay
  • Intermediate/long term (post-discharge)
    • Death, CKD, dialysis, CKD related CV elements
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11
Q

How does mortality change with the stage of AKI?

A

Mortality increases with stage

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12
Q

What are pre-renal causes of AKI?

A
  • Cardiac failure
  • Haemorrhage
  • Sepsis
  • Vomiting and diarrhoea
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13
Q

What are renal causes of AKI?

A
  • Glomerulonephritis
  • Vasculitis
  • Radiocontrast
  • Myeloma
  • Rhadomyolysis
  • Drugs
    • NSAIDs, gentamicin
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14
Q

What are post renal causes of AKI?

A
  • Tumours
  • Prostate disease
  • Stones
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15
Q

What ar esome causes of AKI?

A

Pre-renal:

  • Cardiac failure
  • Haemorrhage
  • Sepsis
  • Vomiting and diarrhoea

Post-renal

  • Tumours
  • Prostate disease
  • Stones

Intrinsic:

  • Glomerulonephritis
  • Vasculitis
  • Radiocontrast
  • Myeloma
  • Rhadomyolysis
  • Drugs
    • NSAIDs, gentamicin
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16
Q

What are examples of drugs that can cause AKI?

A

NSAIDs

Gentamicin

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17
Q

How is AKI prevented?

A

By identifying patients who are at risk

(presence of risk event or risk factor)

18
Q

What are examples of AKI risk events?

A

Sepsis (such as pneumonia, cellulitis, UTI)

Toxins (such as x-ray contrast, NSAIDs, gentamicin, herbal medicine)

Hypotension

Hypovolaemia (such as haemorrhage, vomiting, diarrhoea)

Major surgery

19
Q

What are some risk factors for AKI?

A

Age > 75

Previous AKI

Heart failure

Liver disease

Chronic kidney disease

DM

Vascular disease

Cognitive impairment

20
Q

What is the protocol when identifying patients at risk of AKI?

A

In presence of risk event or factor consider:

  • treat sepsis if present
  • avoid toxins
  • optimise BP and volume status
  • prevent harm
21
Q

Much of AKI is avoidable, how can it be prevented?

A
  • Avoid dehydration
  • Avoid nephrotoxic drugs
  • Review clinical status in those at risk and act on findings
22
Q

What are medicine “sick day rules”?

A

When you have vomiting or diarrhoea (unless only minor) or fever, sweats and shaking you stop taking certain medications

Restart medications when well (24-48 hours after eating and drinking normally)

23
Q

When should medicines be restarted after “sick day” rules?

A
  • Restart medications when are well (after 24-48 hours of eating and drinking normally)
24
Q

What are exampls of medications that should be stopped on “sick days”?

A
  • ACE inhibitors
  • ARBs
  • NSAIDs
  • Diuretics
  • Metformin
25
Q

What investigations should be done for AKI?

A
  • Renal function
  • Urine dipstick
  • FBC
  • USS
  • Blood gas
  • Specific blood tests if indicated
26
Q

What parts of the history are important for AKI?

A
27
Q

What parts of the examination are important for AKI?

A
28
Q

What does RRT stand for?

A

Renal replacement therapy

29
Q

What are potential indications for renal replacement therapy (RRT)?

A
  • Dependant on cause to an extend of at least in the first few hours
    • Acidosis
    • Electrolyte imbalance
    • Intoxication toxins
    • Overload
    • Uraemic complications
30
Q

What electrolyte imbalance can occur in AKI that can have serious consequences?

A

Hyperkalaemia

31
Q

What are ECG changes present in hyperkalaemia?

A
  • Peaked T waves (usually earliest sign of hyperkalaemia)
  • P wave widens and flattens
  • PR segment lengthens
  • P waves eventually disappear
  • Prolonged QRS interval with bizarre QRS morphology
  • High-grade AV block with slow junctional and ventricular escape rhythms
  • Any kind of conduction block (bundle branch blocks, fascicular blocks)
  • Sinus bradycardia or slow AF
  • Development of sine wave appearance
  • Can cause cardiac arrest
    • Asystole
    • Ventricular fibrillation
    • PEA with bizarre, wide complex rhythm
32
Q

What is usually the earliest sign of hyperkalaemia?

A

Peaked T-waves

33
Q

What is the treatment of hyperkalaemia?

A
  • Stabilise (myocardium)
    • Calcium gluconate
  • Shift (K+ intracellularly)
    • Salbutamol
    • Insulin-dextrose
  • Remove
    • Diuresis
    • Dialysis
    • Anion exchange resins
34
Q

What medicine can be used to stabilise the myocardium in hyperkalaemia?

A

Calcium gluconate

35
Q

What medication can be used to shift K intracellular in hyperkalaemia?

A
  • Salbutamol
  • Insulin-dextrose
36
Q

What can be done to remove K from the body in hyperkalaemia?

A
  • Diuresis
  • Dialysis
  • Anion exchange resins
37
Q

What kind of cardiac arrest can hyperkalaemia cause?

A
  • Can cause cardiac arrest
    • Asystole
    • Ventricular fibrillation
    • PEA with bizarre, wide complex rhythm
38
Q

How does the T wave change in hyperkalaemia?

A

Peaked T waves

39
Q

How does the P wave change in hyperkalaemia?

A

Widens and flattens at first

Eventually completely disapears

40
Q

How does the PR segment change in hyperkalaemia?

A

Lengthens

41
Q

How does the QRS complex change in hyperkalaemia?

A

R - Urinary System (Liam Lennox) (29 decks)

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