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Renal > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

What is the relationship between AKI and CKD?

A

Any AKI, no matter how severe, will increase the risk of CKD in the future

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2
Q

The definition of AKI is an abrupt (< 48 hours) reduction in kidney function. How can this be identified?

A

An absolute increase in serum creatinine by > 26.4µmol/l // An increase in creatinine by > 50% // A reduction in urine output

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3
Q

You can only diagnose a patient with AKI following what?

A

Adequate fluid resuscitation and exclusion of obstruction

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4
Q

What defines stage 1 AKI in terms of creatinine?

A

A > 26.4µmol/l increase in creatinine, or 1.5-1.9 x baseline creatinine

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5
Q

What defines stage 1 AKI in terms of urine output?

A

< 0.5 mL/kg/hour for > 6 consecutive hours

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6
Q

What defines stage 2 AKI?

A

Increased creatinine 2-2.9 x baseline // Urine output < 0.5mL/kg/hour for > 12 consecutive hours

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7
Q

What defines stage 3 AKI in terms of creatinine?

A

Increased creatinine > 3 x baseline // Increase to 354 or more // Need for renal replacement therapy

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8
Q

What defines stage 3 AKI in terms of urine output?

A

< 0.3mL/kg/hour for > 24 hours // 12 hours of anuria

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9
Q

What are some risk factors which a patient may have for AKI?

A

Old, CKD, diabetes, cardiac failure, liver disease, PVD, previous AKI

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10
Q

What medical investigation may predispose a patient to getting AKI?

A

Contrast radiography (causes contrast nephropathy)

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11
Q

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

A

Hypotension, hypovolaemia, renal hypoperfusion

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12
Q

What can cause hypovolaemia leading to AKI?

A

Haemorrhage, volume depletion from vomiting, burns

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13
Q

What can cause hypotension leading to AKI?

A

Cardiogenic shock, septic shock, anaphylactic shock

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14
Q

What can cause renal hypoperfusion leading to AKI?

A

NSAIDs/COX2 inhibitors, ACEIs/ARBs, hepatorenal syndrome

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15
Q

What drugs should be stopped in AKI?

A

Drugs to lower BP

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16
Q

What is the definition of pre-renal AKI?

A

Reversible volume depletion leading to oliguria and increase in creatinine

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17
Q

In pre-renal AKI, which will occur first: oliguria or raised creatinine?

A

Oliguria

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18
Q

What defines oliguria?

A

< 0.5mls/kg/hour

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19
Q

What is anuria?

A

Passing no urine

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20
Q

If you are ill, what medication must be stopped?

A

ACE inhibitors

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21
Q

What effect do ACE inhibitors have on GFR? How?

A

Decreased GFR by causing efferent arteriolar vasodilation

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22
Q

Untreated pre-renal AKI leads to what?

A

Acute tubular necrosis

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23
Q

What causes acute tubular necrosis?

A

A combination of factors causing decreased renal perfusion

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24
Q

What are some causes of acute tubular necrosis?

A

Sepsis, severe dehydration, rhabdomyolysis, drug toxicity

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25
Q

What are the two major steps in the treatment of pre-renal AKI?

A

Assess for hydration and fluid challenge for hypovolaemia

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26
Q

What fluid should be used for pre-renal AKI?

A

Crystalloid (0.9% NaCl) or colloid (gelofusin)

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27
Q

How should fluid be given in pre-renal AKI?

A

Give bolus and then reassess and repeat as necessary

28
Q

When should you seek help for a pre-renal AKI?

A

If you’ve given over 1l of fluid and there has been no improvement

29
Q

What is the definition of renal AKI?

A

Diseases causing inflammation or damage to cells causing AKI

30
Q

What are the 4 broad causes of renal AKI?

A

Vascular, glomerular, interstitial, tubular

31
Q

What are some vascular causes of AKI?

A

Vasculitis, renovascular disease

32
Q

What is the glomerular cause of AKI?

A

Glomerulonephritis

33
Q

What are some causes of interstitial nephritis causing renal AKI?

A

Drugs, infection (TB), systemic disease (sarcoidosis)

34
Q

What are some causes of tubular injury causing renal AKI?

A

Ichaemia, drugs, contrast, rhabdomyolysis

35
Q

What drugs are the commonest causes of interstitial nephritis?

A

Antibiotics (particularly gentamicin) and PPIs

36
Q

What are some symptoms of AKI?

A

Constitutional symptoms (anorexia, weight loss, fatigue), N+V, itch, fluid overload (oedema, SOB)

37
Q

What are some signs of AKI?

A

Fluid overload e.g. oedema, effusions // uraemia e.g. itch, pericarditis // oliguria

38
Q

If there is haematuria, where is the most likely place of AKI?

A

Renal

39
Q

Recent contrast indicates which type of AKI?

A

Renal

40
Q

What blood tests should be done to assess renal AKI?

A

Us and Es, FBC and coagulation screen, immunology,

41
Q

What are some investigations which should be used in renal AKI?

A

Urinalysis, USS

42
Q

What investigations are used for myeloma?

A

Protein electrophoresis and BJP

43
Q

If a patient with AKI is anaemic, what are some more likely causes?

A

CKD or haemorrhage

44
Q

What do small kidneys suggest?

A

Chronic kidney problems

45
Q

Anti-GBM antibodies are suggestive of what disease?

A

Goodpasture’s syndrome

46
Q

What are some indicators of myeloma as a cause for AKI?

A

High Ca++ and low haemoglobin

47
Q

What are urgent indications for renal biopsy?

A

Suspected rapidly progressive GN, positive immunology

48
Q

What are semi-urgent indications for renal biopsy?

A

Unexplained AKI, rule out obstruction, volume depletion and ATN

49
Q

When should you not do a renal biopsy?

A

If the patient is on warfarin, aspirin etc // The patient is not normotensive // The patient has hydronephrosis

50
Q

Which kidney should you biopsy? What test should you check it with?

A

Left kidney, use ultrasound

51
Q

What should happen if patients with AKI remain anuric with uraemia?

A

Dialysis

52
Q

What are some life threatening complications of AKI?

A

Hyperkalaemia, fluid overload (pulmonary oedema), severe acidosis (< 7.15) uraemia pericardial effusion, severe uraemia (> 40)

53
Q

What is the definition of a post-renal AKI?

A

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

54
Q

What are some causes of post renal AKI?

A

Stones, cancers, strictures, extrinsic pressure

55
Q

What is the first step in management of a post renal AKI? Why?

A

Put in a catheter- sometimes it is only retention and this will relieve the obstruction

56
Q

After insertion of a catheter, what are the next steps in the management of a post-renal AKI?

A

Nephrostomy, referral to urology for uretering stenting

57
Q

Hyperkalaemia is associated with what life threatening complication?

A

Cardiac arrhythmias

58
Q

A potassium of what is classed as hyperkalaemia? What is life threatening hyperkalaemia?

A

> 5.5, life threatening is > 6.5

59
Q

How do you assess for hyperkalaemia?

A

ECG and muscle weakness

60
Q

What are the major ECG changes which are seen in hyperkalaemia?

A

Tall T waves, broad QRS, no P wave

61
Q

What will happen to the heart rate in hyperkalaemia?

A

Bradycardic

62
Q

What is the 1st step in the management of hyperkalaemia?

A

Cardiac monitor and IV access

63
Q

What medication is given in hyperkalaemia to protect the myocardium?

A

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

64
Q

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

A

Insulin (act rapid 10 units), with 50mls 50% dextrose // nebulised salbutamol

65
Q

What medication is given in hyperkalaemia to prevent K+ absorption from the GI tract? Is this given acutely?

A

Calcium resonium, don’t give acutely

66
Q

What can be given in hyperkalaemia to control the acidosis?

A

Sodium bicarbonate

67
Q

What are some urgent indications for haemodialysis in AKI?

A

Hyperkalaemia, severe acidosis, fluid overload, urea > 40, pericardial rub/effusion

Renal (8 decks)

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