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Year 2- Urinary > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

Acute kidney injury is defined as being an increase in serum creatinine by how much AND urine volume of how much?

A

Increase in serum creatinine: by ≥ 26.5 μmol/l (0.3 mg/dl ) within 48 hours
or
to ≥ 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days

AND
Urine volume <0.5ml/kg for 6hrs

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2
Q

What are some of the immediately dangerous consequences of AKI?

A

Acidosis
Electrolyte imbalance
Intoxication
Overload
Uraemic complications

AEIOU

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3
Q

For AKI Stage 1, what is the serum creatinine level?

A

1.5-1.9 x the baseline

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4
Q

For AKI Stage 1, what is the urine output?

A

<0.5ml/kg/h for 6-12hrs

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5
Q

For AKI Stage 2, what is the serum creatinine level?

A

2-2.0 x the baseline

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6
Q

For AKI Stage 2, what is the urine output?

A

<0.5ml/lg/h for >12hrs

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7
Q

For AKI Stage 3, what is the serum creatinine level?

A

3 x the baseline

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8
Q

What are some of the pre-renal causes of AKI?

A

Cardiac failure
Haemorrhage
Sepsis
Vomiting and diarrhoea

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9
Q

What are some of the intrinsic causes of AKI?

A

Glomerulonephritis
Vasculitis
Radiocontrast
Myeloma
Rhabdomyolysis
Drugs e.g. NSAIDs, gentamicin

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10
Q

What are some post-renal (obstruction) cause of AKI?

A

Tumours
Prostate disease
Stones

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11
Q

What are some risk factors for AKI?

A

Age >75
Previous AKI
Heart failure
Liver disease
CKD
Diabetes
Vascular disease
Cognitive impairment

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12
Q

What are some risk events for AKI?

A

Sepsis
Toxins
Hypotension
Hypovolaemia
Major surgery

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13
Q

List some toxins which should be avoided if a patient is at risk of AKI.

A

Gentamicin
NSAIDs
IV iodinated contrast

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14
Q

There are some medications which should not be taken if someone has vomiting or diarrhoea, fevers, sweats and shaking.
They can be restarted when the individual is well.
Give some examples of these medicines.

A

ACEi
ARBs
NSAIDs
Diuretics
Metformin

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15
Q

Give some examples of ACEi

A

Ramipril, lisinopril

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16
Q

Give some examples of ARBs

A

Candesartan, valsartan

17
Q

Give some examples of NSAIDs

A

Ibuprofen, naproxen

18
Q

Give some examples of diuretics

A

Furosemide
Spironolcatone

19
Q

RECAP- what is metformin used in the treatment of?

A

Diabetes

20
Q

Assessing volume status in a patient with AKI is essential.
If a patient is hypovolaemic, what should be done?

A

Give boluses of fluid as per IV perscription guidelines
Then treat as per euvolaemia*

*normal amount of fluids in the body

21
Q

Assessing volume status in a patient with AKI is essential.
If a patient is euvolemic, what should be done?

A

Give only maintenance fluid

22
Q

The response to AKI can be remembered using the acronym SHOUT.
Run through this please!

A

Suspect sepsis

Hypovolaemia

Obstruction- consider bladder scan and/or ultrasound

Urinalysis

Toxins

23
Q

What kind of investigations are carried out in someone with suspected AKI?

A

Renal function test
Urine dipstick
FBC
USS
Blood gas

More specific blood tests if required

24
Q

What blood tests would routinely get done for someone with suspected AKI?

A

U&Es
Bicarb
LFT’s
FBC
Clotting

25
Q

What we be looked at in urinalysis using a urine dipstick for someone with suspected AKI?

A

Blood?
Protein?

26
Q

Using the acronym BUMP, what gets covered/considered in an AKI review?

A

Bloods

Ultrasound?

Medicines - to ensure appropriate dose adjustments

Plan for fluid maintenance

27
Q

What should be done in an AKI follow-up?

A

Repeat bloods to ensure back to normal
Treatment and medicine review

28
Q

What changes would be seen in an ECG if a patient had hyperkalaemia?

A

Peaked T waves
P wave widens and flattens
PR segment lengthens
P waves eventually disappear
Prolonged QRS interval
Arrhythmias

->Tall T waves are usually one of the earliest signs of hyperkalaemia

29
Q

Describe the treatment for hyperkalaemia.

->apparently one of the most important slides for our future careers uh oh

A

Firstly, stabilise the heart and myocardium by giving calcium gluconate.

This is essential but doesn’t do anything to potassium levels so potassium needs to be shifted intracellularly. This can be done by using a salbutamol nebuliser or giving an insulin-dextrose infusion.

Then remove the excess potassium using diuresis, dialysis or potassium binders

->wordy but please just try and read through and get the basics

30
Q
A

Year 2- Urinary (22 decks)

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