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Renal and Urology > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

what does the kidney interstitium comprise of mainly in health

A

microvascular capilaries

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2
Q

what is the function of the mesangium in the glomerulus

A

structural support

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3
Q

definition of AKI

A

increase in serum creatinine of >26.5 umol/l in 48 hours
increase in serum creatine of 50% more than baseline within 7 days
urine volume <0.5ml/kg/hr for 6 hours

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4
Q

when would someone be started on dialysis for AKI

A

when they are AKIN stage 3
probably in ICU

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5
Q

types of AKI

A

pre renal
renal
post renal

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6
Q

pre renal causes of AKI

A

hypovolaemia (e.g. haemorrhage)
3rd space fluid loss (e.g. pancreatitis)
diuretics
hypotension (e.g. septic shock, liver failure)
reduced renal blood supply secondary to severe renovascular disease, aortic dissection
renal artery stenosis

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7
Q

post renal causes of AKI

A

prostate hypertrophy or cancer
bladder lesions or cancer
ureter calculi or tumour or compression from another tumour

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8
Q

does post renal AKI have to involve both kidneys or just one

A

both
or one if only one present

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9
Q

what is hydronephrosis

A

swelling of one or both kidneys that occurs when there is a blockage meaning the urine can’t drain

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10
Q

what must be done in all patients with significant AKI

A

an ultrasound scan to exclude or demonstrate obstruction to the renal tract

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11
Q

renal causes of AKI

A

acute tubular injury
renal ischaemia
acute tubular necrosis
interstitial nephritis
glomerulonephritis
and others

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12
Q

what is the commonest cause of AKI in hospitals

A

acute tubular injury

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13
Q

causes of acute tubular injury

A

toxins (e.g. gentamicin, NSAIDs, radio contrast dye)
severe prolonged hypotension
renal hypoperfusion
initial oliguria

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14
Q

what should be done for patients who have diarrhoea and vomiting and are on ACEi

A

ACEi should be stopped to avoid renal hypoperfusion which would cause AKI

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15
Q

what happens to urine output in acute tubular injury AKI

A

initially oliguria
then may be polyuric in recovery phase

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16
Q

which region of the kidney operates at a more hypoxic level

A

medulla

17
Q

3+ protein and 4+ blood on a dipstick suggest what is the most likely cause

A

autoimmune

18
Q

what histology marker is characteristic of rapidly progressive glomerulonerphritis

A

glomerular crescents

19
Q

vascular cause of renal AKI

A

haemolytic uraemic syndrome
- e coli related
- genetic related

20
Q

what can be seen in histology of haemolytic uraemic syndrome

A

glomerular microvascular thrombosis

21
Q

what should you ask about in an AKI history

A

renal history (e.g. CKD, diabetes)
family history
urine volume
drug history (e.g. new drugs, nephrotic drugs - NSAIDs, ACEi, antibiotics)
systemic symptoms (e.g. diarrhoea, rash)

22
Q

what clinical examination should be done for AKI

A

fluid status (JVP, postural BP)
check for evidence of infection
look for rashes
look for joint pathology
arterial bruits
palpate bladder
check drug chart

23
Q

what does the anti-nuclear factor test for

A

SLE

24
Q

what does the anti-neutrophil Ab test for

A

vasculitis

25
Q

what does the anti-GBM Ab test for

A

Goodpasture’s syndrome

26
Q

what investigation is important to do in AKI if there is hyperkalaemia

A

ECG

27
Q

treatment prinicples of AKI

A

optimise fluid balance and circulation
stop exacerbating factors (e.g. drugs)
appropriate prescribing (e.g. lower doses)
supportive treatment as appropriate (e.g. dialysis, nutrition)

28
Q

treatment of obstructive/post renal AKI

A

drain renal tract

29
Q

treatment of sepsis

A

effective antibiotics

30
Q

treatment of RPGN

A

immunosuppression

31
Q

treatment of Goodpasture’s syndrome

A

plasma exchange

32
Q

treatment of compartment syndrome

A

fasciotomy

33
Q

when should you start dialysis

A

severe uraemia
- no prospect of immediate improvement
- uraemic encephalopathy or seizures
- uraemic pericarditis
hyperkalaemia unresponsive to medical treatment
fluid overload (esp. pulmonary oedema) resistant to treatment with diuretics/fluid restriction
severe acidosis

34
Q

problems and complications of haemodialysis in AKI

A

pneumothorax
infection
bleeding
anticoagulation required which may be problematic in patients with bleeding
hypotension may be troublesome in some patients

Renal and Urology (16 decks)

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