Acute Kidney Injury

Question 1

what is AKI

Answer 1

abrupt reduction in kidney function as an increase in serum creatinine by > 26.4micromol/l or increase of baseline by 50% or reduction in urine output

Question 2

what are pre renal causes of AKI

Answer 2

hypovolaemia- biggest cause, hypotension, drugs- NSAIDS, COX2 inhibitors, ACEi,

Question 3

what is oliguria

Answer 3

less urine passed 0.5ml/kg/ hour

Question 4

what happens to GFR when started on an ACEi

Answer 4

creatinine goes down

Question 5

what do you need to do if start vomiting and diarrhoea when on ACEi and NSAIDS?

Answer 5

stop medication through illness

Question 6

what does pre renal AKI lead to?

Answer 6

Acute tubular necrosis

Question 7

what is the commonest cause of AKI in hospital

Answer 7

Acute tubular necorsis

Question 8

what are the commonest causes of AKI

Answer 8

dehydration and sepsis

Question 9

how do you treat AKI

Answer 9

assess hydration status- JVP, pulmonary oedema, oedema,
hypovolaemia treatment
Do not give 5% dextrose- won’t go into intravascular volume

Question 10

what are renal causes of AKI

Answer 10

vasculitis- ANCA, glomerular diseases- glomerulonephritis, good pastures, infective endocarditis, acute tubular necrosis, drugs- antibiotics, PPi and NSAIDS, tubular injury- rhabdomyolysis, contrast, drugs

Question 11

what are signs and symptoms of AKI

Answer 11

nausea and vomiting, WL, anorexia, fluid overload, pulmonary oedema, pericardial rub, pericarditis

Question 12

what are clues to renal cause

Answer 12

sore throat- pos strep?
D and V- ACEi
Cough up blood- Goodpastures
urinalysis- protein and blood 
recent contrast? Can precipitate AKI

Question 13

what can compartment syndrome lead to

Answer 13

rhabdomyalysis

Question 14

what are investigations in AKI

Answer 14

U and Es
FBC and coag screen- sepsis 
Urinalysis
USS- obstruction?
GBM- good pastures, ANA-SLE, ANCA- vasculitis
Myeloma screen for > 50s

Question 15

when would you do a renal biopsy

Answer 15

when vasculitis is suspected

Question 16

what should you makes sure the patient is not on in before renal biopsy

Answer 16

aspirin, warfarin,

Question 17

what are life threatening complications of AKI

Answer 17

hyperkalaemia, fluid overload, severe acidosis, uraemic pericardial effusion, severe uraemia

Question 18

what a repost renal causes of AKI

Answer 18

stones, cancers, strictures, extrinsic pressure

Question 19

what is seen on imaging in post renal obstruciton

Answer 19

dilated renal pelvis

Question 20

what cardiac problem is hyperkalaemia associated with

Answer 20

cardiac arrhythmias

Question 21

what is the hyperkalaemic values for non life threatening and life threatening hyperkalaemia

Answer 21

> 5.5 and >6.5

Question 22

what ECG sign is seen in hyperkalaemai

Answer 22

‘tented T waves’

Question 23

how do you treat acute hyperkalaemia

Answer 23

cardiac monitor and IV access
10mls 10% calcium glutinate
Insulin and dextrose
salbutamol nebuliser

Question 24

what are the indications for Haemodialysis

Answer 24

hyperkalaemia >7 or unresponsive to medical therapy

Sever acidosis ph 40- pericardial rub/ effusion

Question 25

what is the prognosis of AKI alone?

Answer 25

10-30%

Question 26

do most people recover fully from AKI

Answer 26

yes- but some develop CKD

Question 27

what are risk factors for developing AKI

Answer 27

diabetes, age, comorbidity, CKD

Question 28

what are 3 nephrotoxic drugs

Answer 28

ACEi, ARB, contrast,