Acute Kidney Injury Flashcards
What do kidneys act like? Why is blood cleaned by the kidneys before returning to the heart?
Sieves filtering waste and excess fluid
To remove waste and excess fluid
How does blood enter the kidneys? How does clean blood return to the body from the kidneys?
Via renal arteries
Through the renal veins
What are the mini-filtering systems inside the kidneys called?
Nephrons
What happens to substances the body needs after the blood is sieved by nephrons?
They are reabsorbed
What form do waste products and extra fluid take when removed from the body?
Urine
What stores urine until it is full? What carries urine from the kidneys to the bladder? How does urine pass out of the body?
The bladder
Ureters
Via the urethra
Approximately how many litres of blood do the kidneys process each day? Approximately how many miles of ‘tubes’ are within the kidneys?
190L
145 miles
What hormone do the kidneys produce that prompts bone marrow to make red blood cells?
Erythropoietin
Besides filtering blood, what else do kidneys produce?
Hormones and chemicals
What do red blood cells carry that the body needs to function? What condition can develop without healthy red blood cells?
Oxygen
Anaemia
What is one potential effect of diseased kidneys on blood pressure?
BP increases
What can high blood pressure, caused by kidney disease, increase the risk of?
Stroke, heart disease and kidney damage
What vitamin do the kidneys produce?
Vitamin D
What balance do kidneys maintain in the blood and bones?
Calcium and phosphate
What was Acute Kidney Injury formally known as?
Acute renal failure
What is the estimated cost to the NHS of acute kidney injury per year?
£434 million to £620 million
What does AKI increase the risk of, according to long-term follow-up studies?
Chronic kidney disease
What can chronic kidney disease lead to?
End-stage renal disease
What is AKI defined as?
Sudden kidney failure or damage
What imbalance does the build up of waste products in the blood during AKI cause?
Homeostatic imbalance
What does AKI cause to build up in the blood?
Waste products
What are the three classifications of AKI?
Pre-renal
Post-renal
Intrinsic
What characterises pre-renal AKI? What can cause pre-renal AKI? What characterises post-renal AKI? What can cause post-renal AKI?
Reduced blood flow to kidneys
Bleeding, sepsis, cardiac failure, dehydration
Obstruction of urine flow
BPH, cancer, renal calculi, blood clots
What causes intrinsic AKI?
Damage to the kidney tissues
What is Acute Interstitial Nephritis? What are the symptoms of Acute Interstitial Nephritis?
Hypersensitivity reaction often drug-induced
Proteinuria, haematuria, eosinophilia, pyrexia, rash, arthralgia
According to KDIGO definitions, what rise in serum creatinine within 48 hours indicates AKI?
26 micromole/litre or greater
What percentage rise in serum creatinine, within 7 days, indicates AKI?
50% or greater
What fall in urine output for more than 6 hours in adults indicates AKI? What fall in eGFR in children and young people within the past 7 days indicates AKI?
Less than 0.5 ml/kg/hour
25% or greater
What are the signs and symptoms of AKI? What are some neurological symptoms of AKI in severe cases?
Too little urine, swelling, fatigue, shortness of breath
Seizures or coma
Besides physical symptoms, how else can AKI be detected?
Through routine testing
What underlying condition involving the kidneys is a risk factor for AKI? What cardiac condition is a risk factor for AKI? What chronic disease is a risk factor for AKI?
CKD
Congestive cardiac failure
Diabetes
What age group is at higher risk for AKI? What vascular condition is a risk factor for AKI?
Older age
Hypertension
What class of drugs is a risk factor for AKI? What systemic infection is a risk factor for AKI?
ACEi
Sepsis
What is involved in the management of Acute Kidney Injury?
Fluid management
Prescription review
Investigate for acute kidney injury
What is the importance of strict fluid balance in AKI management? When administering fluid boluses, what must be done regularly?
Avoid fluid overload
Fluid status review
In fluid management, what is the general target for Input compared to Output?
Input = Output + 30
If a patient has evidence of fluid overload, what should be considered?
Restrict fluid intake and consider loop diuretic
When reviewing prescriptions for AKI, what action should be taken?
Adjust doses if needed
When should loop diuretics be routinely offered in AKI?
When treating fluid overload
What should be measured to investigate for acute kidney injury?
Serum creatinine
What stage of AKI is Patient X in with a creatinine level of 246 µmol/L? What stage of AKI is Patient Y in with a creatinine level of 196 µmol/L? What stage of AKI is Patient Z in with a creatinine level of 259 µmol/L?
Stage 2
Stage 1
Stage 2
What is AKI regarding mortality? What can AKI lead to if not treated quickly?
Independent risk factor
Uraemic complications
What causes pulmonary oedema in AKI? What are the metabolic complications of AKI?
Impaired salt and water excretion
Hyperkalaemia and metabolic acidosis
What is the primary focus of AKI management?
Identifying and treating potential causes
What is uraemia commonly associated with? When can uraemia occur with acute kidney injury (AKI)?
Chronic kidney disease
If loss of renal function is rapid
What is known about the specific uremic toxin responsible for all clinical manifestations of uraemia?
No single toxin has been identified
What medicines cause kidney injury by acute tubular necrosis?
Aciclovir
Cephalosporins
Cisplatin
Fureosemide
Methotrexate
NSAIDs
Paracetamol
Vancomycin
What medicines cause kidney injury pre-renally?
Diuretics
NSAIDs
ACEi
Antihypertensives
Laxative abuse
What medicines cause kidney injury by acute interstitial nephritis?
Allopurinol
Amlodipine
Carbamazepine
Diltiazem
Loop diuretics
NSAIDs
Phenytoin
PPIs
Thiazide diuretics
What medicines cause kidney injury post-renally?
Anticoagulants
Beta-blockers
Methyldopa
What medicines cause kidney injury by rhabdomyolysis (damaged skeletal muscle breakdown)?
Barbiturates
BZDs
Fibrates
Opioids
Theophylline
Statins
