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AY Renal > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

What is AKI?

A

An abrupt (26.4umol/l
OR increase in creatinine by >50%
OR reduction in urine output

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2
Q

What is AKI?

A

An abrupt (26.4umol/l
OR increase in creatinine by >50%
OR reduction in urine output

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3
Q

What causes pre-renal AKI?

A

Reversible volume depletion leading to oliguria & increase in creatinine

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4
Q

How is oliguria defined?

A
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5
Q

Pathophysiology of how reduced volume causes AKI

A

Decreased effective intravascular volume
Increased ADH & Aldosterone
Salt & Water retention
Oliguria > AKI

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6
Q

Causes of pre-renal AKI volume deplteion

A

Hypovolaemia
Hypotension
Renal hypoperfusion

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7
Q

Causes of hypovolaemia

A

Haemorrhage

Volume depleteion #(e.g. D&V, burns)

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8
Q

Causes of ypotension

A 
Cardiogenic shock 
Disruptive shock (e.g. sepsis, anaphylaxis)
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9
Q

Causes of renal hypoperfusion

A

NSAIDs/COX-2
ACEi/ARBS (angiotensin II mediaes arteriolar vasoconstriction therefore increasing GFR)
Hepatorenal syndrome

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10
Q

What is the consequence of untreated pre-renal AKI

A

Acute tubular necrosis

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11
Q

What are causes of acute tubular necrosis

A

Sepsis
Sever dehydration
Rhabdomyolysis
Drug toxicity

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12
Q

Treatment of prerenal AKI

A

Fluid challende

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13
Q

Which should not be used when fluid challenging pre-renal AKI atients?

A

5% dextrose

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14
Q

What is renal AKI?

A

Diseases causing inflammation or damage to cells causing AKI

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15
Q

Blood vessel causes of renal AKI

A

Vasculitis

Renovascular disease

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16
Q

Interstitial injuries that cause renal AKI

A

Drugs
Infection (TB)
Systemic (Sarcoid)

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17
Q

Tubular injuries that cause renal AKI

A

Ischaemia
Drugs (gentamcici)
Contrast
Rhabdomyolysis

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18
Q

Symptoms & signs of AKI

A 
Constitutional symptoms 
Nausea & vomiting 
Itch 
Fluid overload (oedema etc.)
Uraemia 
Oliguria
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19
Q

Initial investigations in AKI

A 
U&E's 
FBC & coagulation screen 
Urinalysis 
USS 
Immunology 
Protein electrophoresis & BJP
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20
Q

What does Bence Jones protein suggest?

A

Myeloma

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21
Q

Urgent indications for renal biopsy

A

Suspected rapidly progressive GN

Positive immunology & AKI

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22
Q

What should be checked before a patient undergoes a renal biopsy?

A

Normal clotting
Normotensive
No hydronephrosis

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23
Q

What are the life threatening complications of AKI?

A

Hyperkalaemia
Fluid overload
Severe acidosis (pH 40)

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24
Q

What is post-renal AKI?

A

AKI due to obstruction of urine flow leading to back pressure (hydronephrois) and thus loss of concentrating ability

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25
Q

Causes of obstruction

A

Stones
Cancers
Strictures
Extrinsic pressure

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26
Q

Imaging for post-renal AKI

A

USS & CT (show dilated renal pelvis)

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27
Q

What treatment can be used to relieve obstruction?

A

Catheter

Nephrostomy

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28
Q

How is hyperkalaemia & life threatening hyperkalaemia defined?

A

Hyperkalaemia = >5.5.

Life threatening hyperkalaemia = >6.5 `

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29
Q

How is hyperkalaemia assessed?

A

ECG

Muscle weakness

30
Q

ECG changes in hyperkalaemia (in order they appear as K+ increases)

A 
Peaked T waves 
Flattened P wave 
Prolonged PR interval 
Depressed ST segment 
Prolonged QRS 
Sine wave pattern
31
Q

What is given to stabilise the myocardium in hyperkalaemia

A

10ml 10% calcium gluconate

32
Q

What treatment is given in hyperkalaemia to move K+ back into cells

A

Insulin (actrapid 10 units) with 50ml 50% dextrose

Salbutamol Nebs

33
Q

What is given (not in acute setting) to prevent potassium reabsorption from GI tract?

A

Calcium resonium

34
Q

What are the indications for dialysis?

A 
Hyperkalaemia (unresponsive to therapy)
Severe acidosis (pH 40, pericardial rub/effusion
35
Q

3 examples of nephrotoxic drugs

A

Gentamicin
NSAIDs
ACEi/ARBs

36
Q

3 examples of nephrotosic drugs

A

Gentamicin
SAIDs
ACEi/ARBs

37
Q

What causes pre-renal AKI?

A

Reversible volume depletion leading to oliguria & increase in creatinine

38
Q

How is oliguria defined?

A
39
Q

Pathophysiology of how reduced volume causes AKI

A

Decreased effective intravascular volume
Increased ADH & Aldosterone
Salt & Water retention
Oliguria > AKI

40
Q

Causes of pre-renal AKI volume deplteion

A

Hypovolaemia
Hypotension
Renal hypoperfusion

41
Q

Causes of hypovolaemia

A

Haemorrhage

Volume depleteion #(e.g. D&V, burns)

42
Q

Causes of ypotension

A 
Cardiogenic shock 
Disruptive shock (e.g. sepsis, anaphylaxis)
43
Q

Causes of renal hypoperfusion

A

NSAIDs/COX-2
ACEi/ARBS (angiotensin II mediaes arteriolar vasoconstriction therefore increasing GFR)
Hepatorenal syndrome

44
Q

What is the consequence of untreated pre-renal AKI

A

Acute tubular necrosis

45
Q

What are causes of acute tubular necrosis

A

Sepsis
Sever dehydration
Rhabdomyolysis
Drug toxicity

46
Q

Treatment of prerenal AKI

A

Fluid challende

47
Q

Which should not be used when fluid challenging pre-renal AKI atients?

A

5% dextrose

48
Q

What is renal AKI?

A

Diseases causing inflammation or damage to cells causing AKI

49
Q

Blood vessel causes of renal AKI

A

Vasculitis

Renovascular disease

50
Q

Interstitial injuries that cause renal AKI

A

Drugs
Infection (TB)
Systemic (Sarcoid)

51
Q

Tubular injuries that cause renal AKI

A

Ischaemia
Drugs (gentamcici)
Contrast
Rhabdomyolysis

52
Q

Symptoms & signs of AKI

A 
Constitutional symptoms 
Nausea & vomiting 
Itch 
Fluid overload (oedema etc.)
Uraemia 
Oliguria
53
Q

Initial investigations in AKI

A 
U&E's 
FBC & coagulation screen 
Urinalysis 
USS 
Immunology 
Protein electrophoresis & BJP
54
Q

What does Bence Jones protein suggest?

A

Myeloma

55
Q

Urgent indications for renal biopsy

A

Suspected rapidly progressive GN

Positive immunology & AKI

56
Q

What should be checked before a patient undergoes a renal biopsy?

A

Normal clotting
Normotensive
No hydronephrosis

57
Q

What are the life threatening complications of AKI?

A

Hyperkalaemia
Fluid overload
Severe acidosis (pH 40)

58
Q

What is post-renal AKI?

A

AKI due to obstruction of urine flow leading to back pressure (hydronephrois) and thus loss of concentrating ability

59
Q

Causes of obstruction

A

Stones
Cancers
Strictures
Extrinsic pressure

60
Q

Imaging for post-renal AKI

A

USS & CT (show dilated renal pelvis)

61
Q

What treatment can be used to relieve obstruction?

A

Catheter

Nephrostomy

62
Q

How is hyperkalaemia & life threatening hyperkalaemia defined?

A

Hyperkalaemia = >5.5.

Life threatening hyperkalaemia = >6.5 `

63
Q

How is hyperkalaemia assessed?

A

ECG

Muscle weakness

64
Q

ECG changes in hyperkalaemia (in order they appear as K+ increases)

A 
Peaked T waves 
Flattened P wave 
Prolonged PR interval 
Depressed ST segment 
Prolonged QRS 
Sine wave pattern
65
Q

What is given to stabilise the myocardium in hyperkalaemia

A

10ml 10% calcium gluconate

66
Q

What treatment is given in hyperkalaemia to move K+ back into cells

A

Insulin (actrapid 10 units) with 50ml 50% dextrose

Salbutamol Nebs

67
Q

What is given (not in acute setting) to prevent potassium reabsorption from GI tract?

A

Calcium resonium

68
Q

What are the indications for dialysis?

A 
Hyperkalaemia (unresponsive to therapy)
Severe acidosis (pH 40, pericardial rub/effusion
69
Q

Risk factors for AKI

A

Age
Diabetics
CKD
Co-morbidity

70
Q

3 examples of nephrotosic drugs

A

Gentamicin
SAIDs
ACEi/ARBs

AY Renal (15 decks)

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