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The Renal System > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

How can acute kidney injury be defined?

A

Abrupt (<48hrs) reduction in kidney function defined as:

An absolute increase in serum creatinine by >26.4µmol/l

OR

An Increase in creatinine by >50%

OR

A reduction in UO

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2
Q

How can acute kidney injury be staged?

A

KDIGO 3 stage classification

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3
Q

What are the main risk factors for AKI?

A
  • Older Age
  • CKD
  • Diabetes
  • Cardiac Failure
  • Liver Disease
  • PVD
  • Previous AKI
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4
Q

Which exposure risk factors can increase the risk of hypovolaemia?

A
  1. Hypotension
  2. Hypovolaemia
  3. Sepsis
  4. Recent contrast
  5. Drugs
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5
Q

Into which three broad classifications can the causes for AKI be grouped?

A

Pre-renal

Renal

Post-renal

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6
Q

What are the 3 main pre-renal causes of AKI?

A
  1. Hypovolaemia
  2. Hypoperfusion
  3. Hypotension
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7
Q

How can pre-renal AKI be defined?

A

Reversible volume depletion leading to oliguria & increase in creatinine

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8
Q

What is normal urine output and from this, how is oliguria defined?

A

0.5ml/kg/hr

Oliguria = anything less than that

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9
Q

How do ACEI decrease blood pressure?

A

Inhibiting angiotensin II which normally constricts the efferent renal arteriole to maintain a higher blood pressure

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10
Q

Why should ACEI be stopped in illness?

A

Can cause acute kidney injury

Blood pressure will drop due to disease and also ACEI resulting in renal hypoperfusion

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11
Q

What is the most common form of AKI in hospital?

A

Acute tubular necrosis

(from untreated pre-renal AKI)

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12
Q

What can cause acute tubular necrosis?

A

Severe dehydration

Sepsis

(less common = rhabdomyolysis and drug toxicity)

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13
Q

How is pre-renal AKI treated?

A

Fluid challenge (if required from fluid assessment)

Crystalloid (0.9% NaCl) or Colloid (Gelofusin)

Bolus then reassess, generally can give up to 1litre before seeking help

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14
Q

In basic terms, what is renal AKI?

A

Diseases causing inflammation or damage to cells causing AKI

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15
Q

Renal AKI can manifest in which 4 ways?

A
  1. Vascular
  2. Glomerular disease
  3. Interstitial Injury
  4. Tubular Injury
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16
Q

What can cause interstitial AKI?

A
  1. Drugs
  2. Infection (TB)
  3. Systemic (sarcoid)
17
Q

What can cause tubular injury in renal AKI?

A
  1. Ischaemia—prolonged renal hypoperfusion
  2. Drugs (gentamicin)
  3. Contrast
  4. Rhabdomyolysis
18
Q

What are the symptoms of AKI?

A
  1. Anorexia, weight loss, fatigue, lethargy
  2. Nausea & Vomiting
  3. Itch
  4. Fluid overload (oedema, SOB)

They are non-specific symptoms

19
Q

Which signs are associated with AKI?

A
  1. Fluid overload (hypertension, Oedema, Pulmonary oedema, effusions (pleural & pulmonary))
  2. Uraemia (itch, pericarditis)
  3. Oliguria
20
Q

Which electrolyte is important to measure in AKI?

A

Potassium

(high shows poor kidney function)

21
Q

What are the main life-threatening associations with AKI?

A
  1. Hyperkalaemia
  2. Fluid Overload (Pulmonary oedema)
  3. Severe Acidosis (pH < 7.15)
  4. Uraemic pericardial effusion
  5. Severe Uraemia (Ur >40)
22
Q

Wnhat is post-renal AKI?

A

AKI caused by obstruction distal to the kidneys

Back-pressure of urine causes hydronephrosis and failure of urine concentration

23
Q

What are the main causes of post-renal AKI?

A

Stones, Cancers, Strictures, Extrinsic Pressure

24
Q

How is post-renal AKI treated?

A

Relieve obstruction

  1. Catheter
  2. Nephroscomy
25
Q

What is the normal range for potassium in the blood?

A

3.5-5mmol/l

26
Q

At which level is hyperkalaemia classified as life threatening?

A

>6.5mmol/l

(>5.5mmol/l is classed as hyperkalaemia)

27
Q

How can hyperkalaemia be assessed?

A

ECG

Muscle weakness

28
Q

How can hyperkalaemia present on ECG?

A
  1. Tall T waves
  2. Loss of P waves
  3. Bradycardia
  4. Wide QRS
29
Q

What is the treatment for hyperkalaemia?

A

Protect myocardium

  • 10mls 10% calcium gluconate (2-3mins)

Move K+ back into the cells

  • Insulin (actrapid 10units) with 50mls 50% dextrose (30 mins)
  • Salbutamol Nebs (90 mins)

Prevent absorption from GI tract

  • Calcium resonium (NOT in the acute setting)

Acidosis

  • Sodium bicarbonate
30
Q

What are the key indications for haemodialysis?

A
  1. Hyperkalaemia (>7 or >6.5 and unresponsive to medical therapy)
  2. Severe Acidosis (pH < 7.15)
  3. Fluid overload
  4. Urea >40, pericardial rub/effusion

The Renal System (37 decks)

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