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Z Year3 Urology > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

What is AKI?

A

sudden rapid reduction in eGFR with or without oliguria/anuria – couple weeks

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2
Q

What is oliguria?

A

reduction in urine output

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3
Q

What is anuria?

A

complete cessation of urine production

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4
Q

What is the KDIGO criteria based on?

A

serum Cr or urine output

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5
Q

What are serum Cr levels for Stage 1 AKI?

A
  1. Based on: Baseline x1.5 more than baseline
    OR
  2. ≥26 umol/L (≥0.3 mg/dL) increase in baseline
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6
Q

What are urine output levels for Stage 1 AKI?

A

<0.5mL/kg/h for 6-12h

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7
Q

What are serum Cr levels for stage 2 AKI?

A

Baseline x2 -2.9

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8
Q

What are urine output levels for stage 2 AKI?

A

<0.5mL/kg/h for ≥12h

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9
Q

What are serum Cr levels for stage 3 AKI?

A
  1. Baseline x3 or over

2. ≥354 umol/L (≥4 mg/dL) increase

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10
Q

What are urine output levels for stage 3 AKI?

A
  1. 0.3mL/kg/h for 24h
  2. Anuria for 12h
  3. Or if patient on Renal replacement therapy (dialysis)
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11
Q

Which parameter do you use to determine stage if they are conflicting?

A
  • You will use the parameter that gives the worst disease state
  • (i.e.: if a patient has peed <0.5mL/lg/h in the last 6 hours but has an increase in serum creatinine 2.5 times their baseline, then you will stage their AKI as stage 2 rather than 1)
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12
Q

What are the possible complications for an AKI?

A
  1. Fluid overload
  2. Uraemia
  3. Metabolic acidosis
  4. Hyperkalaemia
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13
Q

What are the symptoms of fluid overload?

A

pulmonary oedema

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14
Q

What is the management of fluid overload?

A
  1. IV furosemide/ GTN infusion

2. haemodialysis if refractory

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15
Q

What are symptoms of uraemia?

A
  1. Uraemic encephalitis (lethargy, confusion)

2. uraemic pericarditis

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16
Q

What is the management of uraemia if symptomatic?

A

haemodyalsis

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17
Q

What are symptoms of metabolic acidosis?

A
  1. Confusion
  2. tachycardia
  3. Kussmaul’s breathing
  4. N&V
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18
Q

What is the management for metabolic acidosis?

A
  1. IV/PO sodium bicarbonate

2. dialysis if refractory

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19
Q

How do you asses fluid overload?

A
  1. JVP
  2. pitting oedema
  3. crackles on chest
  4. capillary refill
  5. BP
  6. HR
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20
Q

What are symptoms of hyperkalameia?

A
  1. Asymptomatic
  2. Arrhythmias
  3. Muscle weakness
  4. Cramps
  5. Parasthesias
  6. Hypotension
  7. Bradycardia
  8. Cardiac arrest
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21
Q

What are K levels for mild hyperkalaemia?

A

5.5-6

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22
Q

What are K levels for moderate hyperkalaemia?

A

6.1-6.5

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23
Q

What are K levels for severe hyperkalaemia?

A

K>6.5 OR Any K with ECG changes and symptomatic

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24
Q

How do you manage hyperkalamia?

A
  1. Cardiac monitor
  2. Calcium gluconate: 10% 30mls IV
  3. 10U soluble insulin
  4. 50mls of 50% glucose
  5. Also may benefit from:
    - Salbutamol nebulisers
    - IV furosemide
    - IV sodium bicarb (if acidosis)
  6. Stop offending cause, continuous monitoring of K+
  7. If refractory, start haemodyalisis
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25
Q

What does of calcium gluconate is given for hyperkalamia?

A

10% 30mls IV

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26
Q

Why do you give calcium gluconate in hyperkalamia?

A

protects the heart

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27
Q

What dose of soluble insulin do you give in hyperkalamia?

A

10U

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28
Q

What dose of glucose do you give in hyperkalamia?

A

50mls of 50% glucose

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29
Q

Why do you give soluble insulin in hyperkalamia?

A

drives excess K+ into cells and out of blood

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30
Q

Why do you give glucose in hyperkalamia?

A

avoids hypoglycaemia

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31
Q

What are ECG changes in hyperkalamia?

A
  1. Peaked T wave
  2. Wide PR interval
  3. Wide QRS duration
  4. Loss of P wave
  5. Sinusodial wave
  6. Bradycardia
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32
Q

When do you treat hyperkalamia?

A

only if severe

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33
Q

What investigations are done for AKI?

A
  1. Fluid assessment
  2. ABG/VBG, potassium & bicarb – gets quick K
  3. Bloods
  4. Hepatitis/HIV screen, vasculitic screen, myeloma screen, anti-GBM… Sepsis screen (if septic)
  5. KUB
  6. ECG
  7. Good medication history
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34
Q

How do you do a fluid assessment?

A

check membranes, cap refill

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35
Q

What bloods are ordered for AKI?

A
  1. FBC
  2. U&Es
  3. CRP
  4. LFTs
  5. CK
  6. clotting
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36
Q

How is AKI managed?

A
  1. ABCDE approach
  2. Find and treat cause
  3. STOP ANY NEPHROTOXIC DRUGS
  4. Fluid management
  5. Treat complications
  6. Dialysis if necessary
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37
Q

How would you treat the hypovolaemia in AKI?

38
Q

How would you treat the hypervoleamia in AKI?

A

Offloading with IV diuretics or dialysis

39
Q

What can you stop asap?

A

IV not oral as could be allergy etc

40
Q

What are the categories causes of AKI?

A
  1. Renal: problems with kidney tissue
  2. Pre-renal: problems with blood supply
  3. Post-renal: problems with urine outflow
41
Q

What is pre-renal AKI caused by?

A

caused by decreased kidney perfusion

42
Q

What are 3 categories for pre-renal AKI?

A
  1. Hypovolaemia
  2. Low volume
  3. Vascular insult
43
Q

What can lead to the hypovolaemia (excessive fluid losses) in pre-renal AKI?

A
  1. Acute hemorrhage
  2. GI losses
  3. Diuresis
  4. Burns
  5. Third-spacing: sepsis and acute pancreatitis
44
Q

What can lead to the low volume (low effective circulating volume) in pre-renal AKI?

A
  1. Heart failure (Cardiorenal Syndrome)

2. Liver failure (Hepatorenal Syndrome)

45
Q

What can lead to the vascular insult (damage to arteries/arterioles supplying the kidneys) in pre-renal AKI?

A
  1. ACEi/ARBs
  2. NSAIDs
  3. Contrast
  4. Renal artery stenosis
46
Q

What are signs of hypovolaemia?

A
  1. tachycardia
  2. hypotension reduced skin turgor
  3. cool extremities
47
Q

What is cardiorenal syndrome?

A

AKI + signs of HF

48
Q

What is hepatorenal syndrome?

A

AKI + signs of decompensated liver disease

49
Q

What is post-renal AKI caused by?

A

obstruction of urine outflow

50
Q

What are the 3 categories of post-renal AKI causes?

A
  1. Luminal
  2. Mural
  3. Extramural
51
Q

What can cause luminal post renal AKI?

A

kidney stones

52
Q

What are symptoms of kindey stones?

A
  • Urethra: Pain, Anuria

- Ureters: Renal colic

53
Q

What can cause mural post-renal AKI?

A
  1. Cancers of renal tract

2. Strictures

54
Q

What can cause extramural post-renal AKI?

A
  1. Abdominal/ pelvic cancers

2. BPH

55
Q

What is renal colic?

A

intermittent loin-to-groin excruciating pain

56
Q

What is renal AKI caused by?

A

intrinsic kidney damage

57
Q

What are different categories for causes of renal AKI?

A
  1. Tubular
  2. Interstitial
  3. Vascular
  4. Glomerular
58
Q

What is the tubular cause of renal AKI?

A

acute tubular necrosis (ATN)

59
Q

What are two causes of ATN?

A
  1. Ischaemic

2. Toxic

60
Q

How does ischaemic ATN happen?

A
  1. Damage to tubular cells 2º to prolonged and severe ischemia
  2. Decreased blood flow (2º to shock, HF, renal artery stenosis, excessive GI fluid loss…)
61
Q

How does toxic ATN happen?

A

direct effects of nephrotoxins on tubular cells (endogenous and exogenous)

62
Q

What endogenous toxins can cause ATN and AKI?

A
  1. Myoglobulin
  2. Uric acid (tumor lysis syndrome)
  3. monoclonal light chains (multiple myeloma)
63
Q

What exogenous toxins can cause ATN and AKI?

A
  1. Aminoglycosides
  2. cisplatin
  3. NSAIDs
  4. Heavy metals
  5. radiocontrast agent
64
Q

How do you diagnose ATN?

A 
Granular muddy brown casts 
on urinalysis (MSU)
65
Q

What is treatment for ATN?

A
  1. Reversible: Recovery within 21 days approx.

2. After initial insult causing ATN patients develop profound diuresis

66
Q

How do you manage this profound diuresis?

A
  1. strict urine input and output monitoring

2. IV fluids to keep up with losses

67
Q

What is the interstitial cause of renal AKI?

A

Acute interstital necrosis (AIN)

68
Q

What is AIN?

A

Immune-mediated damage of renal interstitium

69
Q

What sort of a reaction is AIN?

A

driven by a Type 4 hypersensitivity reaction, usually to medication

70
Q

What medications can cause AIN?

A
  1. NSAIDs
  2. Thiazide diuretics
  3. Penicillin
71
Q

What is recovery like for AIN?

A

within weeks of removing offending agent

72
Q

How does AIN present?

A
  1. rash
  2. fever
  3. arthralgia
  4. eosinophilia (aka. Signs & Sx of an allergic reaction)
73
Q

What can you see on urinalysis in AIN?

A

White cell casts

on urinalysis

74
Q

What are two causes of vascular renal AKI?

A

HUS and TTP

75
Q

What is HUS?

A

haemolyic uraemia syndrome

76
Q

What is TTP?

A

Thrombotic

Thrombocytopenia Purpura

77
Q

What are symptoms of HUS?

A
  1. Haemolytic anaemia
  2. AKI
  3. Thrombocytopenia
  4. Jaundice
  5. Schistcytes
  6. Dark urine
78
Q

What are neurological symptoms in TTP?

A
  1. Headaches
  2. confusion
  3. Seizures
  4. partial paralysis
  5. speech abnormalities
  6. mental changes
79
Q

What are signs of anaemia?

A
  1. weakness
  2. fatigue
  3. paleness
  4. SOBOE
80
Q

What are signs of thrombocytopenia?

A
  1. Petechiae

2. heavy bleeding

81
Q

What is TTP?

A

HUS symptoms with fever and neurological symptoms

82
Q

What is the patho of vascular renal AKI?

A

damage to renal capillaries leading to formation of microthrombi

83
Q

What causes HUS?

A
  • Most common in children, 2º to EHEC infection

* Presents with bloody diarrhoea

84
Q

What is management of HUS?

85
Q

What is EHEC?

A

Entero-haemorhagic Eschicheria Ecolis (release of Shiga toxin)

86
Q

What is TTP caused by?

A
  1. ADAMTS 13 deficiency (both autoimmune or congenital)

2. Enzyme responsible for vWF breakdown

87
Q

What is the management of TTP?

A
  1. Plasmapherisis

2. Rituximab

88
Q

What is the glomerular cause of renal AKI?

A

glomerulonephritis

89
Q

What is glomerulonephritis?

A
  1. Damage to glomerulus
  2. Inflammation of glomerular capillaries and glomerular basement membrane
  3. Usually immune-mediated
90
Q

What are the two presentations of glomerulonephritis?

A
  1. Nephrotic

2. Nephritic

Z Year3 Urology (18 decks)

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