Acute Kidney Injury Flashcards
What 2 things in the urine can indicate acute kidney injury?
High urea + creatinine levels (+ low urine output)
What is stage 3 of acute kidney injury?
It is x3 someones baseline creatinine levels, resulting in worse outcomes
In which people is AKI more common in?
Elderly, and people in ICU
Why can trimethoprim increase creatinine levels?
Because it can slow down the excretion of creatinine in the kidneys
What are the 3 types of acute renal failure? How is each one mostly treated?
- Pre-renal - kidney is not receiving enough blood - treat with fluids
- Intrinsic renal - direct damage to the kidneys - treat sepsis/damage
- Post renal - obstructions in the kidneys, which can be resolved - treat with catheter/removing blockage
Which cellular component do tubular cells in the kidneys have a lot of?
Mitochondria for energy usage
What is the difference between the afferent and efferent arteriolar vessels?
Afferent: brings blood to the kidneys
Efferent: brings blood out of the kidneys
What happens to transport proteins in the kidneys if there is insufficient blood supply?
Transport proteins move around more & causes reversible tubular damage
What are the presentations/symptoms of AKI?
- Decreased urine output
- Signs of excess fluid - oedema, SOB
- Tiredness, nausea, vomiting
- Rash, oral ulcers, joint swelling
What are the symptoms of volume depletion, vs. volume overload?
Volume depletion:
- Thirst
- Dry mouth
- Excess fluid loss
- Ankle welling, weight gain
Volume overload:
- Reduced skin turgor
- Dry mouth
- Raised JVP
- Tachycardia or hypotension
What investigations are performed for renal failure?
- Bloods
- Urine
- Immunology
What can be observed in a urine microscopy for acute renal failure?
- RBC casts
- WBC casts
- Crystalluria - uric acid crystals
- Granular casts
What are the 4 options available to manage AKI within the first 24h?
- Investigate first with bloods/urine
- Give fluids for rehydration
- Antibiotics
- Catheter
- Adjust/change drugs (e.g. stop NSAIDs/ACEi)
What factors to you monitor during acute renal failure, and how can they be resolved?
- Urine output - dialysis
- Vitals
- ECG - Ca2+/insulin/dextrose if hyperkalaemic
- Respiration - fluids, or dialysis
- Arterial blood gases - if severe acidosis then dialysis
When would dialysis be required for acute kidney injury?
- Hyperkalaemia
- Fluid overload
- Metabolic acidosis
- Multi-organ failure
- Very high creatinine or urea levels
