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14. Nephrology and Urology > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

Which 3 methods can be used to stage AKI?

A

UKRA guidelines
RIFLE criteria
AKI staging

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2
Q

Describe how to stage AKI. (3)

A

STAGE 1:

  • Increased serum creatinine x1.5-2
  • Urine output <0.5ml/kg/hour for 6 hours

STAGE 2:

  • Increased serum creatnine x2-3
  • Urine output <0.5ml/kg/hour for 12 hours

STAGE 3:

  • Increased serum creatinine x3+
  • Urine output <0.3ml/kg/hour for 24 hours, OR
  • Anuria for 12 hours
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3
Q

What are the 3 main categories of causes of AKI?

A

Pre-renal (i.e. circulation problems)
Renal (i.e. intrinsic kidney disease)
Post-renal (i.e. obstruction)

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4
Q

List 5 examples of pre-renal causes of AKI.

A 
Hypovolaemia/hypotension
Hypoxia
Reduced effective circulating volume
Drugs (e.g. ACEI, NSAIDs)
Renal artery stenosis
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5
Q

List 3 causes of reduced effective circulating volume.

A

Heart failure
Sepsis
Cirrhosis

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6
Q

List the 3 types of renal (intrinsic AKI). Give some examples of each.

A

Glomerular disease, e.g.
-Glomerulonephritis

Tubular disease, e.g.

  • Ischaemic acute tubular necrosis
  • Nephrotoxic acute tubular necrosis
  • Myeloma cast nephropathy

Tubulointerstitial disease, e.g.

  • Drugs
  • Myeloma
  • Sarcoidosis
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7
Q

What is the main cause of post-renal AKI in men?

In women?

List 4 other causes.

A

Men: prostatic hypertrophy/malignancy

Women: gynae tumours

Other:

  • Kidney stones
  • Renal papillary necrosis
  • Retroperitoneal fibrosis
  • Urethral strictures
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8
Q

What is the most common cause of renal/intrinsic AKI?

A

Acute tubular necrosis

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9
Q

What is acute tubular necrosis caused by? (2)

Give some examples of each.

A

Ischaemia, e.g.

  • Hypotension
  • Sepsis

Toxins, e.g.

  • Drugs
  • Poisons
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10
Q

List 3 types of exogenous toxins which might cause acute tubular necrosis.

A

Drugs (e.g. NSAIDs, gentamicin, ACEIs)
Contrast materials
Poisons (e.g. metals, antifreeze)

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11
Q

List 5 types of endogenous toxins which might cause acute tubular necrosis.

A 
Myoglobin
Haemoglobin
Immunoglobulins
Calcium
Urate
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12
Q

Describe the histology of acute tubular necrosis on biopsy. (3)

A

Focal loss of tubular epithelial cells
Occlusion of tubular lumen (by cell debris)
Multiple mitoses in tubular epithelium

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13
Q

How can NSAIDs cause AKI? (3)

A
  1. Inhibit dilation of afferent arteriole (by inhibiting prostaglandin production)
  2. Therefore, kidney cannot increase glomerular perfusion pressure when MAP falls
  3. Therefore, if hypotension develops due to any cause, nephrons are at risk of AKI
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14
Q

How do ACE inhibitors cause AKI? (3)

A
  1. Inhibit constriction of efferent arteriole (by inhibiting ACE and therefore angiotensin II formation)
  2. Therefore, the kidney cannot increase glomerular perfusion pressure when MAP falls
  3. Therefore, if hypotension develops due to any cause, nephrons are at risk of AKI
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15
Q

What investigations would you do in AKI? (11)

HINT: these are grouped into 4 types of investigation.

A

Blood tests:

  • U&Es
  • FBC
  • Potassium (often increased)
  • Glomerulonephritis screen: antibodies, immunoglobulins, complement factors

Urine tests:

  • Urine output
  • Urinalysis
  • Urinary Bence-Jones protein

Clinical exam:

  • Fluid status
  • Systematic enquiry

Imaging:

  • Renal ultrasound
  • ECG
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16
Q

How would you manage AKI? (7)

A 
ABCDs
Remove causes of AKI
Correct hypo/hyperkalaemia
Correct acidosis
Dialysis
Call ICU/renal unit
Exclude obstruction
17
Q

How would you treat hyperkalaemia? (3)

Briefly state how each of these drugs work.

A 
Calcium resonium (decreases potassium absorption)
Insulin (moves potassium into cells)
Calcium gluconate (cardiac membrane stabiliser)
18
Q

What is the reference range for potassium?

When would you treat hyperkalaemia?

A

3.5-5.0

<6.0: abnormal, but no immediate concern

  1. 0-6.4: risk of arrhythmias; needs treatment
  2. 5+: medical emergency
19
Q

What are the indications for sodium bicarbonate infusion in AKI?

A

Raised potassium

HCO3- <16

20
Q

What are the absolute indications for dialysis in AKI? (2)

What are the relative indications? (5)

A

ABSOLUTE INDICATIONS
Refractory hyperkalaemia
Refractory pulmonary oedema

RELATIVE INDICATIONS
Acidosis
Uraemia
Pericarditis
Encephalopathy
Toxins present (e.g. lithium)

14. Nephrology and Urology (7 decks)

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