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Year 2 Urinary (JK) > Acute kidney injury > Flashcards

Acute kidney injury Flashcards

1
Q

How is AKI defined?

A

increase in S creatinine by >26.5 micromole in 48 hrs
increase in S creatinine by 1.5x in 7 days
urine volume <0.5ml/kg/hr for 6 hours

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2
Q

Immediately dangerous consequences of AKI (AEIOU)

A 
acidosis 
electrolyte imbalance 
intoxication 
overload 
uraemic complications
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3
Q

Short term consequences of AKI

A

hospital stay, dialysis, death,

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4
Q

Long term consequences of AKI

A

CKD, death, dialysis, CKD related CVS events

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5
Q

Pre-renal causes of AKI

A

Hypovolaemia - diarrhoea and vomit, haemorrhage, dehydration
sepsis
hypotension
congestive cardiac failure/liver failure
arterial occlusion
vasomotor eg NSAIDS, ACEI

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6
Q

Renal causes of AKI

A

acute tubular necrosis - ischaemia
toxin related eg NSAIDS, aminoglycosides, contrast
acute glomerulonephritis
acute interstitial nephritis eg PPI’s
myeloma
intra-renal vascular obstruction eg vasculitis

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7
Q

Post renal causes of AKI

A

intraluminal eg clot, calculus
intramural eg malignancy, stricture, fibrosis, Prostate disease
extramural eg malignancy, RPF

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8
Q

Why does pre-renal causes lead to acute tubular necrosis?

A

poor perfusion and lack of circulation to provide sufficient plasma flow to maintain blood chemistry and fluid balance

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9
Q

Is the medulla hypoxic?why?

A

yes
receives 10-15% of renal blood flow
metabolically active

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10
Q

initiation of tubular necrosis

A

exposure to toxic/ischaemic insult

pre-renal parenchymal injury evolving but AKI preventable

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11
Q

Maintenance of tubular necrosis

A

established parenchymal injury and max. oliguric

1-2 weeks –> several months

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12
Q

Recovery of tubular necrosis

A

gradual increase in urine output and fall in serum creatinine

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13
Q

What happens if GFR recovers quicker than tubule resorptive capacity?

A

excessive diuresis

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14
Q

What is radiocontrast nephropathy?

A

hospital AKI following iodinated contrast agent

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15
Q

Risk factors for radiocontrast nephropathy

A 
DM
renovascular disease 
paraprotein
impaired renal function 
high volume of radiocontrast
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16
Q

How is myeloma diagnosed?

A

bone marrow aspirate >10% clonal plasma cells
serum paraprotein and immunoparesis
urinary Bence-jonson protein
skeletal surrey-lytic lesions

17
Q

Common features of myeloma

A

Anaemia, back pain, fractures, weight loss, infections, hypercalcaemia, increase ESR and cord compression

18
Q

Myeloma kidney

A 
cast nephropathy 
amyloidosis 
hypercalcaemia 
light chain nephropathy 
hyperuricaemia
19
Q

History questions for AKI

A

PMH/systemic eg nose bleeds, rash, eyes, joint pain
drug exposure
uraemic symptoms
pre/post renal factors

20
Q

Examination in AKI

A

vital sings eg bp, pulse
volume status
systemic illness eg rash, joints, eyes
obstruction - feel bladder

21
Q

Blood test in AKI

A 
FBC 
U+E
bicarbonate 
clotting
ANCA, Ig, C3 C4 dsDNA
LFT 
bone
22
Q

Other investigations in AKI

A

USS, blood gas, urine dipstick, renal function

23
Q

Situations at risk of AKI

A

sepsis, toxins, hypotension, surgery, hypovolaemia

24
Q

Risk factors for AKI

A 
Age>75
previous AKI 
DM 
heart failure 
vascular disease
25
Q

STOP AKI prevention

A

sepsis - suspect, investigate, treat
toxins = avoid eg NSAIDS, gentamicin, IV contrast
optimise bp and volume status
prevent harm - daily U+E, fluid balance

26
Q

Treatment of AKI

A 
avoid dehydration - give fluids
optimise bp - stop antihypertensives and give vasopressin and fluids 
treat sepsis 
stop nephrotoxic drugs
diagnose glomerulonephritis and treat
27
Q

Hyperkalaemia on ECG

A 
tall tented T waves
p wave widen, flat and disappears 
PR segment lengthens 
prolonged QRS 
high grade AV block and conduction block 
sinus bradycardia or slow AF 
Sine wave appearance
28
Q

Problems with hyperkalaemia

A

cardiac arrest

29
Q

Progression of hyperkalaemia

A

asystole, VF and PEA

30
Q

What hyperkalaemia treatments stabilises the myocardium?

A

calcium gluconate

31
Q

What hyperkalaemia treatment shifts K+ intracellularly?

A

salbutamol

insulin-dextrose

32
Q

What hyperkalaemia treatment removes K+?

A

diuresis, dialysis, anion exchange resins

33
Q

Treatment of intoxication in AKI

A

antidote eg morphine, digoxin

may require RRT

34
Q

4 indications for RRT in AKI

A

low bicarbonate
pulmonary oedema
hyperkalaemia
pericarditis

35
Q

Advantages of haemodialysis

A

rapid solute and volume removal

rapid correction of electrolytes

36
Q

Disadvantages of haemodialysis

A

Haemodynamic instability
concern if associated with hypotension
fluid removal only when being treated

37
Q

Advantages of haemofiltration

A

slow volume removal - haemodynamic stability
absence of volume and solute fluctuations
greater control over volume status

38
Q

Disadvantages of haemofiltration

A

Continuous coagulation

may delay mobilisation

Year 2 Urinary (JK) (26 decks)

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