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renal > acute kidney injury > Flashcards

acute kidney injury Flashcards

1
Q

what defines the different KDIDO staging

A
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2
Q

risk factors for AKI

A

-older age
-CKD
-diabetes
-cardiac failure
-liver disease
-PVD
-previous AKI
-hypotension
-hypovoleamia
-sepsis
-deteriorating NEWS
-recent contrast
0exposure to certain medications

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3
Q

causes of pre-renal AKI

A
  • hypovolaemia (haemorrhage, volume depletion)
  • hypotension (cardiogenic shock, distributive shock)
  • renal hypoperfusion (NSAIDs, ACEis)
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4
Q

what is pre renal AKI

A

reversible volume depletion leading to oliguria and increase in creatinine

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5
Q

what does untreated pre-renal AKI lead to

A

acute tubular necrosis

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6
Q

what is acute tubular necrosis

A
  • due to a combination of factors leading to decreased renal perfusion
  • common causes are sepsis and severe dehydration
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7
Q

treatment for pre renal AKI

A 
assess for hydration 
(JVP, cap refill, BP, HR etc)
fluid challenge for hypovolaemia 
-crystalloid or colloid 
-give bolus of fluid then reassess and repeat
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8
Q

do you give 5% dextrose for pre renal AKI

A

no

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9
Q

what is renal AKI

A

diseases causing damage or inflammation to cells causing AKI

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10
Q

vascular causes of renal AKI

A
  • vasculitis

- renovascular disease

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11
Q

glomerular causes of renal AKI

A

glomerulonephritis

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12
Q

causes of interstitial nephritis (that then causes renal AKI)

A
  • drugs
  • infection
  • systemic (sarcoid)
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13
Q

causes of tubular injury (that then causes renal AKI)

A
  • ischaemia
  • drugs
  • contrast
  • rhabdomyolysis
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14
Q

symptoms of AKI

A
  • constitutional weight loss
  • fatigue
  • nausea and vomiting
  • fluid overload (oedema, SOB)
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15
Q

signs of AKI

A
  • fluid overload including HTN, oedema, pul oedema, effusions
  • uraemia
  • itch
  • pericarditis
  • oliguria
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16
Q

investigations for AKI

A
  • U&E’s
  • FBC and coagulation screen
  • urinalysis
  • USS
  • immunology
  • protein electrophoresis
17
Q

if someone has really small kidneys what does this suggest

A

chronic kidney disease

18
Q

what would ANA point you towards

A

lupus

19
Q

what would ANCA point you towards

A

vasculitis

20
Q

what would GBN point you towards

A
  • vasculitis

- good pastures

21
Q

what do you do if an adequate BP is still not reached after fluid resuscitation

A

inotropes/vasopressors

22
Q

life threatening complications of AKI

A
  • hyperkalaemia
  • fluid overload (pulmonary oedema)
  • severe acidosis
  • uraemic pericardial effusion
  • severe uraemia
23
Q

treatment of post renal AKI

A
  • relieve obstruction (catheter, nephrostomy)

- refer to urology if ureteric stenting required

24
Q

why is hyperkalaemia life threatening

A

associated with cardiac arrythmias

25
Q

how much potassium is hyperkalaemia

A

> 5.5

26
Q

assessment of hyperkalaemia

A
  • ecg

- muscle weakness

27
Q

what level is life threatening hyperkalaemia

A

> 6.5

28
Q

what will normalise the ECG in hyperkalaemia

A

10mls of 10% calcium glucinate

29
Q

treatment for hyperkalaemia

A
  • cardiac monitor and IV access
  • 10mls 10% calcium gluconate (2-3 mins)
  • insulin with 50mls 50% dextrose (30mins)
  • salbutamol nebs (90 mins)
  • calcium resonium to prevent absorption from GI tract
30
Q

urgent indications for haemodialysis

A
  • hyperkalaemia
  • severe acidosis
  • fluid overload
  • urea >40, pericardial rub/effusion
31
Q
A
  1. B
  2. A
  3. C
  4. D
32
Q
A

D

33
Q
A

E

34
Q
A

D

35
Q

treatment for this case?

A
  • restore renal perfusion by giving fluids
  • stop all meds apart from ranitidine
  • treat the hyperkalaemia (IV access, cardiac monitoring etc)
36
Q

which drugs would you avoid in a patient with AKI

A
  • NSAIDs
  • ACE/ARB
  • diuretics
  • gentamicin
  • contrast
  • trimethorpim
  • potassium sparing diuretics

renal (28 decks)

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