Acute Kidney Injury Flashcards

1
Q

What is Acute Kidney Injury?

A
Term replaces Acute Renal Failure
Rapid reduction in kidney function
occurs over hours to days
No specific symptoms 
exception – stones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the expected outcomes for AKI?

A

majority of patients recover kidney function if they recover from the cause
e.g. sepsis and low blood pressure
may require dialysis dependent upon severity of AKI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is creatinine level change associated with mortality?

A

The higher the change in creatinine, the more likely death will result.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What else in the body can AKI affect?

A
Heart
Brain
Lungs
Liver
GI tract
Bone marrow

Potential mediators:
uraemic toxins
cytokines
leukocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What percentage of hospital admissions get AKI?

A

18%

30-80% ICU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the intrinsic causes or AKI?

A
Acute tubular injury
Sepsis
Hypotension
Nephrotoxins:
-drugs
-NSAIDs
-contrast
-Rhabdomyolysis
-myeloma
-snake bites
Tubulointerstitial injury
Glomerulonephritis
Vasculitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are post renal causes of AKI?

A
Kidney stones
Prostatic hypertrophy
Retroperitoneal fibrosis
Cervical Cancer
Urethral stricture
Intra-abdominal hypertension
Obstructed urinary catheter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are pre-renal causes of AKI?

A
Sepsis
Hypotension
- Hypovolemia (vomiting, diarrhoea, haemorrhage)
- Myocardial infarction
- ↓in effective circulating volume
  - cardiac failure
  - liver cirrhosis
Drugs
- diuretics
- ACEi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What can cause excessive fluid losses?

A
fever
diuretics
diarrhoea
high stoma output
haemorrhage
 - trauma, GI 
burns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What might there be a history of in AKI patients?

A

History of

  • kidney stones
  • prostate disease
  • loin pain
  • haematuria

Drug history

  • nephrotoxic drugs
  • iodinated contrast media
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why might there be poor fluid intake?

A

nausea, vomiting
↓urine output
↓ functional capacity - uraemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the signs and symptoms of AKI

A

Low blood pressure
bruises/absent pulses
rash or joint swelling caused by vasculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the possible complications of AKI?

A
Hyperkalaemia
Acidaemia
Pulmonary oedema
Uraemia
 - Pericarditis
 - Encephalopathy
Gastrointestinal:
nausea
vomiting
gastritis
ulceration
Malnutrition

Haematological:
anaemia
bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How can suspected AKI be investigated?

A
Full Blood Count (FBC)
U&Es and bicarbonate (previous renal function)
Liver Function Tests and bone
urinalysis (prior to urinary catheter)
immunological screen
creatine kinase 
 - (rhabdomyolysis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What radiology tecnhiques can be used to invesitgate AKI?

A

Kidneys Ureter Bladder X-ray - stones

ultrasound of renal tract within 24hrs if
obstruction suspected
rare cause suspected requiring a kidney biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are risk factors for AKI?

A
> 75 years
pre-existing chronic kidney disease
vascular disease
diabetes mellitus
cardiac failure
hypovolaemia
sepsis
nephrotoxins
17
Q

What is the pathway for treating AKI?

A

STOP

Sepsis - treat promptly

Toxins
avoid/stop nephrotoxic medications
minimise volume of iodinated contrast

Optimise blood pressure
consider fluids
hold antihypertensive drugs
consider vasopressors

Prevent harm
identify cause
treat complications
review medications

18
Q

How can post renal AKI be treated?

A

The obstruction can be relieved by radiologists and urologists.

19
Q

What is Hartman’s solution?

A

IV fluids but more physiological + potassium containing

20
Q

How can you recognise hyperkalemia on an ECG?

A

Elevated T wave

21
Q

How is hyperkalemia treated?

A

30mls 10% Calcium gluconate over 5-10 min
50mls 50% glucose + 10units soluble insulin
Stop drugs causing  K+
Sodium Bicarbonate
Salbutamol nebulisers
Renal Replacement Therapy

22
Q

How is pulmonary oedema treated?

A
Sit up 
O2 high flow via reservoir mask
(High dose furosemide)
only if volume replete
do not persist if unresponsive
Intravenous nitrates
specific situations
Renal Replacement Therapy
23
Q

What are the 3 forms of intermittent renal replacement therapy?

A

haemodialysis
slow low efficiecy dialysis (SLED)
peritoneal dialysis

24
Q

What are the 3 forms of continuous renal replacement therapy?

A

Continuous Veno-Venous Haemofiltration (CVVH)
CVVDH (Haemodialysis)
CVVHDF (Haemodiafiltration)