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nephrology > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

what is an acute kidney injury?

A

rapid (<7 days) and sustained (lasting >24 hours) reduction in renal failure resuling in oliguria and a rise in serum urea and creatinine

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2
Q

what system is used to classify AKI?

A

KDIGO

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3
Q

how is stage 1 AKI defined?

A

creatinine rise of 1-1.5x compared to baseline

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4
Q

how is stage 2 AKI defined?

A
  • creatinine rise of 2x compared to baseline
    OR
  • urine output <0.5 ml/kg/hour for 12 hours
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5
Q

how is stage 3 AKI defined?

A
  • creatinine rise of 3x compared to baseline
    OR
  • urine output <0.3 ml/kg/hour for 12 hours
    OR
  • anuria for >12 hours
    OR
  • serum creatinine >354 umol/dl
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6
Q

what are the risk factors for developing AKI?

A
  • chronic kidney disease
  • diabetes with chronic kidney disease
  • heart failure
  • renal transplant
  • age 75 or over
  • hypovolaemia
  • contrast administration
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7
Q

what are the pre-renal causes of AKI?

A
  • shock (hypovolaemic, cardiogenic or distributive)
  • renovascular disease (e.g. renal artery stenosis)
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8
Q

what is the most common cause of renal artery stenosis in patients >50 years?

A

atherosclerosis

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9
Q

what are the renal causes of AKI?

A
  • dysfunction in the glomeruli - acute glomerulonephritis
  • tubules - acute tubular necrosis
  • interstitial - acute interstitial nephritis
  • renal vessels - haemolytic uraemia syndrome or vasculitides
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9
Q

what are the post-renal causes of AKI?

A

caused by obstruction to urinary outflow
* luminal (e.g. kidney stone)
* mural (e.g. tumour of the urinary tract)
* due to external compression (e.g. benign prostatic hypertrophy)

e.g. prostate enlargement, stones, external pressures (tumours)

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10
Q

what investigations should be performed in AKI?

A
  • bloods - FBC, U&Es, LFT, glucose, clotting, calcium, ESR
  • ABG
  • urine
  • ECG
  • CXR
  • renal US
  • glomerulonephritis screen
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11
Q

what can be seen on CXR in AKI?

A

pulmonary oedema

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12
Q

what can be seen on renal US?

A

hydronephrosis

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13
Q

name some nephrotoxic drugs

A
  • NSAIDs
  • aminoglycosides e.g. gentamicin
  • ACEi/ARBs
  • diuretics
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14
Q

name some drugs which are renally excreted

A
  • metformin
  • lithium
  • digoxin
  • opioids
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15
Q

what are the indications for dialysis?

A

AEIOU

Acidosis (pH <7.20)
Electrolyte imbalance (K+ >7mmol)
Intoxication
Oedema
Uraemia (encephalopathy or pericarditis)

16
Q

what would warrent stopping a newly started ACEi?

A

creatinine rise >30% above baseline after 2 weeks

17
Q

how does rhabdomyolysis cause AKI?

A

myoglobin products of muscle breakdown is extremely toxic to the glomerulus and can cause an AKI

18
Q

what is a complication from AKI?

A

hyperkalaemia

19
Q

when should metaformin be avoided?

A
  • eGFR <30 mL/minute/1.73m2
  • creatinine >150
20
Q

how does uraemia present?

A
  • nausea
  • vomiting
  • confusion (encephalopathy)
  • seizures
  • coma
  • ‘uraemic tinge’
21
Q

what is ‘uraemic tinge’?

A

brown-grey colour skin

22
Q

when should you suspect acute tubular necrosis?

A

poor response to fluid challenge

23
Q

what is the most common cause of acute kidney injury?

A

acute tubular necrosis

24
Q

what is acute tubular necrosis caused by?

A

necrosis of tubular cells due to ischaemia or nephrotoxins

25
Q

what are the risk factors for AKI?

A
  • age >65
  • chronic kidney disease
  • diabetes
  • heart failure
  • liver disease
  • peripheral vascular disease
25
Q

what are the risk factors for AKI?

A
  • age >65
  • chronic kidney disease
  • diabetes
  • heart failure
  • liver disease
  • peripheral vascular disease
26
Q

name an exacerbating factor for AKI

A
  • anti-hypertensives
27
Q

what is the risk if metformin is not stopped in a patient with AKI?

A

induce lactic acidosis

28
Q

what is the formula to calculate the normal urine output?

A

N = >0.5mls/kg/hr

e.g. 70kg patient = 35mls/hour

29
Q

what are the indications for acute haemodyalysis?

A
  • hyperkalaemia (generall >6)
  • uraemic pericarditis
  • acidaemia
  • pulmonary oedema
30
Q

what is the main underlying pathology in the majority of hospital AKIs?

A

**acute tubular necrosis **
caused by ischaemia or nephrotoxic injury

nephrology (5 decks)

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