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RENAL > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

define uraemia and state some common signs/symptoms

A

the term given to the clinical symptoms which arise when nitrogenous metabolic waste products accumulate in the blood (i.e. urea and creatinine), as a result of decreased filtration of these products by the kidneys
- nausea, vomiting, fatigue, anorexia, weight loss, muscle cramps, pruritus, or changes in mental status.

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2
Q

define AKI

A
  • sudden deterioration of renal function over hours or days
  • urea and creatinine rise rapidly
  • usually but not always associated with oliguria or anuria
  • usually but not always reversible
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3
Q

how is AKI staged

A
  • if 2 tests show different stages, always stage according to the most severe outcome
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4
Q

what are the 3 categories that causes of AKI fall under

A

pre-renal
intrinsic renal
post-renal

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5
Q

what are causes of pre-renal AKI

A
  1. hypovolaemia: e.g. haemorrhage, dehydration, burns
  2. sepsis
  3. shock
  4. renal artery stenosis
  5. NSAIDs or ACEi: impair the mechanisms of renal autoregulation so can predispose to prerenal AKI

Insufficient blood supply (hypoperfusion) to kidneys reduces the filtration of blood

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6
Q

what are causes of intrinsic renal AKI

A
  1. acute tubular necrosis: ischaemia, drug toxicity, toxins
  2. acute intersitial nephritis: due to drugs, infections, hypercalcaemia, multiple myeloma
  3. glomerular disease: acute glomerulonephritis,
  4. vascular disease: vasculitis, malignant hypertension
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7
Q

what are some post-renal causes of AKI

A
  1. calculus: bilateral
  2. bladder outflow obstruction: BPH or urethral/ureteric strictures
  3. tumours
  4. retroperitoneal fibrosis

obstruction to the outflow of urine away from the kidney, causing back-pressure into the kidney and reduced kidney function

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8
Q

what are complications of AKI (4)

A
  1. metabolic acidosis
  2. hyperkalaemia
  3. uraemia –> encephalopathy and pericarditis
  4. volume overload
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9
Q

what bedside tests would be carried out in suspected AKI

A
  • bladder scan
  • urinalysis, microscopy, culture & specimen
  • ECG (K+)
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10
Q

what blood tests would be carried out in suspcted AKI (5)

A
  • daily FBC, U&Es, LFTs, CRP
  • CK if rhabdo suspected
  • anti-streptolysin O titres - post-strep GN
  • haemolysis screen w blood films, LDH, bilirubin - associated thrombocytopenia
  • cryoglobulins - unexplained rash, peripheral neuropathy, hep C
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11
Q

what imaging would be carried out in investigation of AKI

A
  • USS KUB (kidney, ureter, bladder)
  • CT
  • CXR

Ultrasound of the urinary tract assesses for obstruction when a post-renal cause is suspected

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12
Q

what procedures would be carried out in investigating AKI

A
  • nephrostomy
  • cytoscopy
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13
Q

how would you treat pre-renal AKI

A
  • IV fluids to correct hypovolaemia
  • stop potentially nephrotoxic medication e.g. NSAIDs, ACEi
  • diuretics if clinically indicated
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14
Q

how would you treat intrinsic renal AKI

A
  • correct electrolytes
  • renal replacement therapy
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15
Q

how would you treat post-renal AKI

A
  • urinary or supra-pubic catheter
  • ureteric stents
  • nephrostomy
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16
Q

what would you look for peripherally in fluid assessment

A

HR
BP
postural BP
skin turgor

17
Q

what would you look for on the face and neck in fluid assessment

A

sunken eyes
JVP

18
Q

what would you look for in the chest and back on a fluid assessment

A

dull percussion
crepitations at lung bases
sacral oedema

19
Q

would would be signs to look out for in the abdoman and limbs in fluid assessment

A

ascites
ballotable kidneys
palpable bladder
urine output
oedema

20
Q

what are life-threatening complications of AKI

A
  • hyperkalaemia
  • pulmonary oedema
  • bleeding
21
Q

what are the NICE guidelines criteria for diagnosing an AKI

A
  • Rise in creatinine of more than 25 micromol/L in 48 hours
  • Rise in creatinine of more than 50% in 7 days
  • Urine output of less than 0.5 ml/kg/hour over at least 6 hours
22
Q

what are risk factors for developing an AKI

A
  • elderly
  • sepsis
  • CKD
  • IHD/CCF/CVD
  • diabetes
  • meds: NSAIDs, gentamicin, diuretics
  • radiocontrast agent
23
Q

what investigation finding confirms ATN

A
  • muddy brown casts on urinalysis
  • renal tubular epithelial cells may also be seen
24
Q

is ATN reversible?

A

yes as the epithelial cells can regenerate
- recovery usually takes 1-3 weeks

25
Q

what is acute intersitial nephritis caused by

A

an immune reaction associated with:
* drugs: NSAIDs, abx
* infections: E.Coli, HIV
* autoimmune: sarcoidosis, SLE

26
Q

what are you assessing for in urinalysis for AKI

A
  • leucocytes/nitrites: infection
  • protein/blood: acute nephritis but can also be positive in infection
  • glucose: diabetes
27
Q

how is AKI preventable

A
  • Avoiding nephrotoxic medications where appropriate
  • Ensuring adequate fluid intake (including IV fluids if oral intake is inadequate)
  • Additional fluids before and after radiocontrast agents
28
Q

if blood and protein is positive on a urine dipstick for AKI, what further investigation should be ordered and why

A
  • c-ANCA + p-ANCA: vasculitis
  • anti-GBM, ANA, C3/C4: lupus nephritis
  • serum immunogloblulins and electrophoresis: myeloma
29
Q

what are indications for RRT in AKI (AEIOU)

A
  • hyperK refractory to medical therapy
  • metabolic acidosis “ “
  • fluid overload refractory to diuretics
  • uraemic pericarditis
  • uraemic encephalopathy - vomiting, confusion, drowsiness
  • intoxications - ethylene glycol, methanol, salicylates
30
Q

what is the best way to differentiate between AKI and CKD

A

renal USS
- most pt w CKD will have small bilateral kidneys
- hypocalcaemia is often present in CKD due to a lack of vitamin D

31
Q

what common drugs should be stopped in patients with AKI due to them worsening renal function

A
  • NSAIDs
  • aminoglycosides
  • ACEi
  • ARB
  • diuretics

RENAL (7 decks)

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