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Renal and urology > Acute kidney injury > Flashcards

Acute kidney injury Flashcards

1
Q

What is the definition of acute kidney injury?

A 
An abrupt (\<48hrs) reduction in kidney function defined as:
An absolute increase in serum creatinine by \>26.4µmol/l

Increase in creatinine by >50%

A reduction in urine output

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2
Q

What markers are used to stage acute kidney injury?

A

Createnine

Urine output

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3
Q

What is stage 1 acute kidney injury?

A

Createnine:

Increase >26µmol/L or

Increase > 1.5-1.9 x reference Cr

Urine output:

< 0.5 mL/kg/hr for > 6 consecutive hrs

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4
Q

What is the definition of stage 2 acute kidney injury?

A

Creatinine:

Increase > 2 to 2.9 x reference serum Cr

Urine output:

<0.5ml/hour for > 12 hours

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5
Q

What is the definition of stage 3 acute kidney injury?

A

Creatinine (one of):

Increase > 3 x reference serum Cr

Increase to > 354 µmol/L

Need for RRT

Urine output:

<0.3 mL/kg/hr for > 24hrs

12 hrs for anuria

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6
Q

How can causes of acute kidney injury be classified?

A

Prerenal

Renal

Postrenal

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7
Q

What are the main pre-renal causes of AKI?

A

Hypovolaemia

Hypoperfusion

Hypotension

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8
Q

What can cause hypovolaemia resulting in AKI?

A

Haemorrhage

Volume depletion (e.g. D&V, burns)

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9
Q

What can cause hypotension resulting in AKI?

A

Cardiogenic shock

Distributive shock (e.g. sepsis, anaphylaxis)

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10
Q

What can cause renal hypoperfusion causing AKI?

A

NSAIDs / COX-2

ACEi / ARBs
Hepatorenal syndrome

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11
Q

How do NSAIDs cause hypoperfusion of the kidneys?

A

Prostaglandin inhibition/vasodilatation inhibition of the efferent arteriole

Essentially compromises the blood supply to the kidney

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12
Q

Should patients taking ACEi continue their drugs during episodes of D&V?

A

No: renal perfusion is going to decrease during D&V due to significant fluid loss, and continuing ACEi may cause a major fall in GFR

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13
Q

What pathology can be seen in the kidneys if prerenal AKI is left untreated?

A

Acute tubular necrosis

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14
Q

What is the commonest form of AKI in the hospital?

A

Acute tubular necrosis

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15
Q

What are some of the causes of acute tubular necrosis AKI?

A

Sepsis
Severe dehydration

Rhabdomyolysis

Drug toxicity

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16
Q

How can hydration be assessed?

A

Clinical observations (BP, HR, UO)

JVP

Capillary Refill Time

Oedema

Pulmonary oedema

17
Q

How is hypovolaemia treated?

A

Fluid challenge

Crystalloid (0.9% NaCl) or Colloid (Gelofusin)

Give bolus of fluid then reassess and repeat as necessary

If >1000mls IN and no improvement, seek help

18
Q

What are the four types of causes of AKI?

A

Vascular

Glomerular

Interstitial nephritis

Tubular injury

19
Q

What are the symptoms of AKI?

A

Constitutional symptoms:
Anorexia, weight loss, fatigue, lethargy

Nausea & Vomiting

Itch

Fluid overload

Oedema, SOB

20
Q

What are the signs of acute kidney injury?

A

Fluid overload including oedema, pulmonary oedema, effusions (pleural & pulmonary)

Uraemia incl itch, pericarditis

Oliguria

21
Q

What initial blood tests would you do if AKI suspected?

A

U&Es (is potassium high)

FBC and coagulation screen

Urinalysis (proteinuria suggeting active GN)

USS (?Obstruction ?Size)

Immunology (ANA (SLE), ANCA (Vasculitis), GBM (Goodpastures))

Protein electrophoresis & BJP
(?myeloma (everyone over 50yrs))

22
Q

What are the urgent indications for renal biopsy?

A

Suspected rapidly progressive GN

Positive immunology & AKI

23
Q

What are the semi-urgent indications for renal biopsy?

A

Unexplained AKI to gain a diagnosis

Rule out obstruction, volume depletion & acute tubular necrosis

24
Q

What are the life threatening complications of AKI?

A

Hyperkalaemia

Fluid Overload (Pulmonary oedema)

Severe Acidosis (pH < 7.15)

Uraemic pericardial effusion

Severe Uraemia (Ur >40)

25
Q

What causes post-renal AKI?

A

Obstruction

26
Q

What is a normal serum potassium level?

A

3.5-5.0

27
Q

What serum potassium levels define hyperkalaemia and then life-threatening hyperkalaemia?

A

>5.5

>6.5

28
Q

What are the ECG changes seen in hyperkalaemia?

A

Tented/large T waves

P-wave flattening

QRS complex widening

VF then ventricular standstill

29
Q

What drug is given in hyperkalaemia to protect the myocardium?

A

Calcium gluconate

30
Q

Which drugs are given in hyperkalaemia to move potassium back into the cells?

A 
Insulin (actrapid 10units) with 50mls 50% dextrose (30 mins)
Salbutamol nebuliser (90 mins)
31
Q

How long are repeated doses of calcium gluconate and insulin dextrose given?

A

Calcium gluconate until ECG normal

Insulin dextrose until serum potassium normal

32
Q

What are the urgent indications for haemodialysis?

A

Hyperkalaemia: >7 or >6.5 and unresponsive to therapy

Severe acidosis (<7.15)

Fluid overload

Urea >40

Pericardial rub/effusion

Renal and urology (11 decks)

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