Acute Kidney Injury

Question 1

What is acute kidney injury

Answer 1

Rapid and sustained reduction in renal function resulting in oliguria and rise in serum urea and creatinine

Question 2

Risk factors for developing AKI

Answer 2

> 65 years old, eGFR <60mls/min, CKD, diabetes, HF, renal transplant, nephrotoxins, liver disease, cognitive impairment, use of contrast medium

Question 3

What is the most common cause of AKIs

Answer 3

Pre-renal causes - 55%

Question 4

What are pre-renal causes of AKI

Answer 4

Shock - hypovolaemia, hypotension, reduced cardiac output (HF), dehydration, renovascular disease (renal artery stenosis)

Question 5

3 causes of AKI

Answer 5

Pre-renal, renal, post-renal

Question 6

Define what pre-renal causes are that cause AKI

Answer 6

Inadequate blood supply

Question 7

Define what renal causes are that cause AKI

Answer 7

Intrinsic kidney damage and disease

Question 8

Define what post-renal causes are that cause AKI

Answer 8

Obstruction to outflow

Question 9

Renal causes of AKI

Answer 9

Glomerulonephritis, tubular necrosis, interstitial nephritis, HUS - 35% cases

Question 10

Post-renal causes of AKI

Answer 10

Kidney stones, strictures, tumours, enlarged prostate - 20% cases

Question 11

Investigations to conduct in suspected/confirmed AKI

Answer 11

Urine dipstick, US, ABG, ECG

Question 12

General manage in AKI

Answer 12

Correct underlying cause, manage complications, catheterise, stop nephrotoxic drugs

Question 13

Eg of nephrotoxic drugs

Answer 13

NSAIDs, ACEIs, aminoglycosides, diuretics

Question 14

Indications for dialysis

Answer 14

Severe acidosis, persistant hyperkalaemia, intoxication, oedema, uraemia

Question 15

How is AKi diagnosed

Answer 15

Measuring serum creatinine

Question 16

NICE criteria for AKI

Answer 16

Rise in creatinine of ≥ 25 micromol/L in 48 hours
Rise in creatinine of ≥ 50% in 7 days
Urine output of < 0.5ml/kg/hour for > 6 hours

Question 17

Complications of AKI

Answer 17

Hyperkalaemia, fluid overload, heart failure, pulmonary oedema, metabolic acidosis, uraemia which can leadto encephalopathy or pericarditis