Acute Kidney Injury

Question 1

.40 year old male presenting with general malaise & haemoptysis (Urea 28, Creatinine 600, elevated ant-GBM)

Answer 1

Goodpastures

Question 2

25 year old IVDA found collapsed at home

Answer 2

Rhabdomyolosis

Question 3

82 year old man admitted with BP 70 30, T 39, pulse 140bpm, K+ 7.0, urea 48, Cr 789, CRP 250, CXR left basal consolidation

Answer 3

Acute tubular necrosis

Question 4

80 year old male admitted with 4-5 day history of diarrhoea. On admission BP 80 40, pulse 30bpm. Bloods phone back: Na 135, K+ 8.0, Urea 50, Cr 1000, Bicarb 9
. What drug would you start first?

Answer 4

Calcium gluconate

Question 5

Give three ways that you can get pre renal acute kidney injury?

Answer 5

1. Hypovolaemia from d&v/burns
2. Hypotension from sepsis, cardiogenic shock or anaphylaxis
3. Reanl Hypoperfusion due to NSAIDS, ACE, ARBs on a background of poor kidney function and possible a “sick day”

Question 6

Give three causes of acute tubular necrosis?

Answer 6

Untreated pre renal AKI
Rhabdomyolisis
Drug toxicity

Question 7

How do you treat pre renal AKI?

Answer 7

Fluid challenge (0.9% saline)

Question 8

What is the definition of renal AKI?

Answer 8

Disease causing inflammation or damage to the kidney cells causing acute kidney injury.

Question 9

What structures can be damaged in renal AKI?

Answer 9

Blood vessels
Glomerular disease
Interstitial injury
Tubular injury

Question 10

List 6 specific caused of renal AKI?

Answer 10

Vascular
- Vasculitis
Glomerular
- Glomerulonephritis
Interstiaial nephritis
-Drugs
- infection (TB)
-  sarcoidosis
Tubular injury
- Ischaemia due to prolonged renal hypoperfusion
- Gentamicin
- Contrast study
- Rhabdomyolysis

Question 11

What antibodies would you expect to find in SLE?

Answer 11

ANA

Question 12

What antibodies would you expect to find in vasculitis?

Answer 12

ANCA

Question 13

What antibodies would you expect to find in goodpastures?

Answer 13

GBM antibodies

Question 14

How would you treat renal AKI?

Answer 14

1. Fluid resuscitate
2. If still not at adequate BP then inotrpes or vasopressors
3. Treat underlying cause
   eg antibiotics if septic
4. Stop nephrotoxic drugs
5. Dialysis if they are anuric and have uraemia.

Question 15

How do you get post renal AKI?

Answer 15

Due to an obstruction (eg stone, stricture) obstructing the urine flow and causing hydronephrosis with reduces the concentrating ability of the kidney

Question 16

How do you treat post renal AKI?

Answer 16

Relieve obstruction
Catheter
Nephrostomy

Question 17

What counts as hyperkalemia?

Answer 17

Pottassium above 5.5

Question 18

What counts as life threatning hyperkalaemia?

Answer 18

above 6.5