Acute Kidney Injury

Question 0

Give an overview of the causes of oliguria and AKI

Answer 0

Acute tubular necrosis
Rhabdomyolosis - myoglobin toxic to tubule cells
Pre-renal - depletion of blood supply, heart failure, hypovolaemia, systemic vasodilation, reduction in renal perfusion, impaired renal vasodilation, NSAIDs
Renal (intrinsic) - glomerular and arteriolar disease (e.g. acute glomerulonephritis, lupus), haemolytic uraemic syndrome, acute pyelonephritis
Post renal (obstructive) - increased intraluminal pressure, within lumen (calculi, clot, tumour), within wall (strictures), pressure from outside (prostatic hypertrophy, tumour, aortic aneurysm)

Question 1

What is acute kidney injury?

Answer 1

Abrupt decline in actual GFR
Increase in serum creatinine
Urine volume <0.5 ml/kg/h for 6h
Upset of ECF volume, electrolyte and acid/base homeostasis
Accumulation of nitrogenous waste products

Question 2

Describe the methods used to investigate the AKI patient

Answer 2

Blood test
Urinalysis, microscopy
USS
Biopsy

Question 3

Describe the principles of AKI therapy

Answer 3

Fluid resuscitation

Dialysis

Question 4

Name some common drugs that may cause AKI

Answer 4

Gentamicin (antibiotic)
NSAIDS
ACEi