Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Urinary > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

What is acute kidney injury?

A

Reduction in renal function following damage to the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Is acute kidney injury reversible or irreversible?

A

Reversible usually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are risk factors for acute kidney injury?

A
  • Chronic kidney disease
  • Heart failure
  • Diabetes
  • Liver disease
  • Older age (above 65 years)
  • Cognitive impairment
  • Nephrotoxic medications such as NSAIDS and ACE inhibitors
  • Use of a contrast medium such as during CT scans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What drugs are a risk for acute kidney injury?

A

Nephrotoxic drugs- ACE inhibitors and NSAID’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How many stages of AKI are there?

A

Three

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the characteristics of stage 1 AKI?

A
  • Creatinine increased by at least 1.5x baseline
  • Rise in creatinine by more than 26µmol/L in the last 48 hours
  • Urine output can be normal or less than 0.5ml/kg/hr for 6-12 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the characteristics of stage 2 AKI?

A
  • Creatinine increased by 2-2.9x baseline

* Urine output less than 0.5/ml/kg/hr for more than 12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the characteristics of stage 3 AKI?

A
  • Creatinine increased by 3x baseline

* Urine output less than 0.3ml/kg/hr for more than 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the causes of AKI divided into?

A

Pre-renal
Renal
Post-renal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are pre-renal causes of AKI due to?

A

Ischaemia or lack of blood flow to the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the pre-renal causes of AKI?

A
  • Heart failure or liver failure
  • Hypovolaemia- haemorrhage
  • Renal artery stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What will improve kidney function if the cause is pre-renal?

A

Restore perfusion to the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the renal causes of AKI due to?

A

Intrinsic damage to the glomeruli, renal tubules or interstitium of the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the renal causes of AKI?

A
  • glomerulonephritis
  • acute tubular necrosis (ATN)
  • acute interstitial nephritis (AIN),
  • drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What drugs can cause AKI?

A

NSAID’s

ACEi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the post-renal causes of AKI due to?

A

Problems after the kidneys, where there is an obstruction to the urine coming from the kidneys resulting in things ‘backing-up’ and affecting the normal renal function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are post renal causes of AKI?

A
  • kidney stone in ureter or bladder
  • benign prostatic hyperplasia
  • external compression of the ureter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most common cause of AKI?

A

Acute tubular necrosis?

19
Q

What is acute tubular necrosis?

A

Necrosis of renal tubular epithelial cells affects the functioning of the kidney.

20
Q

Is acute tubular necrosis reversible?

A

In the early stages it is reversible if the cause if removed.

21
Q

What are the 2 main causes of Acute tubular necrosis?

A

Ischaemia
Nephrotoxins

22
Q

What is the ischaemic cause of Acute tubular necrosis?

A

Sepsis
Shock

23
Q

What are the nephrotoxic causes of acute tubular necrosis?

A

Aminoglycosides
Rhabdomyolysis
Radiocontrast agents
Lead

24
Q

What are the main features of acute tubular necrosis

A

Features of AKI: raised urea, creatinine, potassium

Muddy brown casts in the urine

25
Q

What would you find in the urine of someone with acute tubular necrosis?

A

Muddy brown casts

26
Q

Who does rhabdomyolysis occur in?

A

Typically in an elderly person who has fallen and doesn’t move for a few days

27
Q

What is rhabdomyolysis also known as?

A

Long lie

28
Q

What is rhabdomyolysis due to?

A

Prolonged immobility leads to rapid muscle breakdown

There is therefore an EXTREMELY high serum creatine kinase

29
Q

What is the diagnostic level of creatinine in rhabdomyolysis?

A

Creatinine over 400 µmol/l indicated end stage renal failure and no past medical history

30
Q

What are the features of rhabdomyolysis?

A
  • acute kidney injury with disproportionately raised creatinine
  • elevated creatine kinase (CK)
  • myoglobinuria
  • hypocalcaemia (myoglobin binds calcium)
  • elevated phosphate (released from myocytes)
  • hyperkalaemia (may develop before renal failure)
  • metabolic acidosis
31
Q

What are possible causes of rhabdomyolysis?

A
  • seizure
  • collapse/coma (e.g. elderly patients collapses at home, found 8 hours later)
  • ecstasy
  • crush injury
  • McArdle’s syndrome
  • drugs: statins (especially if co-prescribed with clarithromycin
32
Q

What is the most common cause of rhabdomyolysis?

A

Elderly person that has fallen and not moved for hours

33
Q

What is the management of rhabdomyolysis?

A
  • IV fluids to maintain good urine output

* urinary alkalinization is sometimes used

34
Q

Which medications should be stopped as they can worsen renal funciton?

A
  • NSAIDs
  • Aminoglycosides
  • Angiotensin 2 receptor antagonists/ ARB
  • Metaformin
  • ACE inhibitors
  • Naproxen
35
Q

When should you stop metformin?

A

When AKI eGFR less than 45ml/min

36
Q

What is the management of AKI?

A

Fluid rehydration with IV fluids in pre-renal AKI

Stop nephrotoxic medication-NSAIDS and antihypertensives that reduce the filtration pressure (i.e. ACE inhibitors)

Relieve obstruction in a post-renal AKI- insert a catheter for a patient in retention from an enlarged prostate

37
Q

What is a differential of an AKI?

A

Dehydration

38
Q

How can an AKI be differentiated from dehydraiton?

A

Creatinine isn’t as raised as the urea- urea will be high

Urea will be raised more in dehydration than the creatinine

39
Q

What are classed as nephrotoxic drugs?

A

ACE inhibitors
ARBs
NSAIDs
Diuretics (furosemide)

40
Q

What other medication might you need to stop in someone with an AKI?

A

Lithium

41
Q

Why might you need you stop lithium in someone with an AKI?

A

Due to increased risk of toxicity- it is excreted by the kidneys

42
Q

What does a lack of protein in the urine rule out?

A

Pre-renal and Post renal (damage is in the kidneys)

43
Q

What can differentiate acute interstitial nephritis from acute tubular necrosis?

A

The WCC will be higher in someone with acute interstital nephritis as it is an inflammatory process

Urinary (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions