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227 Acute Kidney Injury > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

What is the name given to the criteria for ranking kidney injury?

A

RIFLE criteria

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2
Q

Name some of the major extra-renal effects of AKI

A

Pulmonary function - fluid overload → oedema, ARDS

CNS - Electrolyte imbalance, altered conscious level, confusion, convulsions, coma

Cardiac - Heart failure, cardiac hypertrophy, arrythmias

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3
Q

What type of ARF are the following classed as:

Intravascular volume depletion

Decreased effective blood volume

Altered intrarenal haemodynamics

A

Pre-renal ARF

GFR reduced as a result of haemodynamic disturbances → decreased glomerular perfusion (basically not enough fluid)

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4
Q

How does systemic vasoconstriction affect the glomeruli pressure?

A

The inlet is under systemic control, therefore there will be vasoconstriction

The outlet is controlled locally, therefore it will not be affected by systemic effects

Therefore systemic vasoconstriction → decreased glomerular pressure

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5
Q

How it the outlet of the glomerulus controlled mainly?

A

It is controlled locally, by angiotensin II → constriction

If angiotensin II blocked, outlet opening increases, so pressure decreases

e.g. Ramipril - ACE inhibitor

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6
Q

Name some common types of intrinsic acute renal failure

A

Acute tubular necrosis

Acute interstitial nephritis

Acute glomerulonephritis

Acute vascular syndromes

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7
Q

Which type of AKI will have its renal function restored when the altered haemodynamic factors are reversed by giving fluids?

A

Pre-renal AKI - no cellular injury

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8
Q

What type of AKI is caused by third space sequestration?

A

Pre-renal AKI

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9
Q

How is pre-renal ARF diagnosed?

A

Hx and Examination

high BUN to Cr ratio (BUN:Cr > 20:1)

Abnormal urine chemistry

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10
Q

What are the clinical manifestations of third space sequestration?

A

Respiratory compromise

Cardiac - decreased CO

GI - intestinal ischaemia

Hepatic dysfunction

Oliguric renal failure - if intrabdominal pressure >15mmHg → oliguria; >30mmHg → anuria

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11
Q

What is the treatment for Third Space Sequestration?

A

Abdominal decompression

Paracentesis - drain abdomen

Surgical decompression

Renal failure usually recovers after relief of intra-abdominal pressure

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12
Q

What is the major aetiology of Post-renal AKI?

A

Obstruction - stone, fibrosis, clot, cancer, bladder pathology

  • Hydroureter
  • Hydronephrosis
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13
Q

What is the treatment for post-renal faliure?

A

Treatment of cause

After relief of obstruction: monitor for post-op diuresis (parenteral fluid)

Monitor electrolyte loss with polyuria

Treat metabolic acidosis

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14
Q

What is the most common form of intrinsic ARF?

A

Acute tubular necrosis

  • Nephrotoxic
  • Ischaemic
  • Multifactorial
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15
Q

What happens to the cells in acute tubular necrosis recovery?

A

They dedifferentiate and remaining viable tubular epithelial cells proliferate

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16
Q

How does radio-contrast affect the kidney?

A

It induces vasodilation followed by prolonged vasoconstriction

This leads to renal ischaemia and ROS release: Direct tubular toxicity

17
Q

How is Acute tubulo-interstitial nephritis diagnosed?

A

Exposing factor: drug, infection

Fever/Rash

Arthralgia

Oesinophilia/Oesinophiluria

Biopsy: Cellular infiltrate in tubulo-interstitium

18
Q

What is the treatment for acute tubulo-interstitial nephritis?

A

Withdraw offending agent

Steroids

19
Q

What are the life threatening complications of AKI?

A

Metabolic Acidosis

Hyperkalaemia

Acute pulmonary oedema

20
Q

What are the clinical effects of acidosis?

A

Muscle weakness

Altered mental state

Kussmaul breathing - to reduce CO2 in blood

Hyperkalaemia - K moves out to balance

Hypotension (negative inotropic effect)

21
Q

What is the treatment for metabolic acidosis?

A

Treat the cause

Volume expansion

IV Sodium Bicarbonate (pH <7.1)

Dialysis

22
Q

What are the clinical effects of hyperkalaemia?

A

Muscle weakness:

Smooth muscle - constipation

Cardiac muscle effects

ECG signs: Tall slender peak T waves, broad QRS (→very broad QRS)

23
Q

What is the treatment for hyperkalaemia?

A

Treat cause

IV Calcium gluconate - balance Ca and K for heart

IV dextrose insulin/IV salbutamol - shift K into intracellular compartment

Bicarbonate therapy - correct acidosis

Cation exchange resin: Ca polystyrene

227 Acute Kidney Injury (8 decks)

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