Acute Kidney Injury

Question 1

how quickly does an AKI occur

Answer 1

in <48hr

Question 2

which drugs are risk factors for AKI

Answer 2

contrast, ACEI, ARB, NSAID, metformin, genta, trimethoprim, diuretic

Question 3

what is a stage 1 AKI

Answer 3

Cr >26 OR >1.5-1.9X baseline
or
UO <0.5/hr for >6hr

Question 4

what is a stage 2 AKI

Answer 4

Cr >2X baseline
or
UO <0.5/hr for >12hr

Question 5

what is a stage 3 AKI

Answer 5

Cr>3X baseline or >354 
or 
need RRT 
or 
UO <0.3/hr for >12hr

Question 6

how are the causes of AKI classified

Answer 6

pre-renal, renal, post-renal

Question 7

causes of pre-renal AKI

Answer 7

decrease blood volume, decreased blood pressure, hypoperfusion e.g. shock

Question 8

causes of renal AKI

Answer 8

acute tubular necrosis, GN, acute interstitial nephritis, small vessel vasculitis

Question 9

causes of acute tubular necrosis

Answer 9

drugs, uraemia, ischaemia from pre-renal, hepatorenal synd, rhabdomyolysis

Question 10

what drugs can cause acute tubular necrosis

Answer 10

NSAID, ACEI, contrast, genta

Question 11

causes of acute interstitial nephritis

Answer 11

TB, SLE, sarcoid, drugs, pyelonephritis

Question 12

what drugs can cause acute interstitial nephritis

Answer 12

PPI, fluclox hypersensitivity, NSAID

Question 13

causes of post-renal AKI

Answer 13

obstruction e.g. stircture, tumour, stone

Question 14

what types of shock can cause pre-renal AKI

Answer 14

distributive, cardiogenic

Question 15

what electrolyte disturbance is caused by rhabdomyolysis

Answer 15

hyperkalaemia

Question 16

what is the 1st thing to do in suspected AKI

Answer 16

stop nephrotoxic drugs, diuretics, and antihypertensives

Question 17

investigations for AKI

Answer 17

bloods, urinalysis, US kidney

Question 18

what blood tests for AKI

Answer 18

U+E, FBC, Hb, bicarb, coag screen

Question 19

what tests should you do if urinalysis is positive

Answer 19

ANA, ANCA, complement, UPCR

Question 20

what can you get from renal US in AKI

Answer 20

can see hydronephrosis, and size/scarring helps determine if pre-existing renal disease

Question 21

what are the red flags for myeloma

Answer 21

> 50 yr + anaemia + hypercalcaemia

Question 22

what test should you do additionally if you suspect myeloma

Answer 22

bence jones protein

Question 23

what test should you do if immunology is positive

Answer 23

biopsy

Question 24

what are the contraindications to biopsy

Answer 24

taking warfarin/aspirin

Question 25

what is the 1st treatment step in AKI

Answer 25

250ml crystalloid bolus (then reassess/repeat till euvolaemia, unless >1L; get help)

Question 26

what drugs should you give for AKI if BP is down

Answer 26

inotrope / vasopressor

Question 27

management of post-renal AKI

Answer 27

catheter or nephrostomy

Question 28

when is haemodialysis indicated for AKI

Answer 28

K>7, pH <7.15, fluid overload, urea >40

Question 29

management of AKI if suspected vasculitis

Answer 29

IV CCS (+- later cyclophosphamide, TPE)

Question 30

commonest complication of AKI

Answer 30

hyperkalaemia

Question 31

presentation of >K

Answer 31

cardiac arrhythmia, muscle weakness

Question 32

what is hyperkalaemia levels

Answer 32

>5.5

Question 33

what are life threatening hyperkalaemia levels

Answer 33

>6.5

Question 34

remember always do an ECG in hyperkalaemia. what is seen on ECG

Answer 34

tall T waves, decreased HR, broad QRS

Question 35

management of hyperkalaemia

Answer 35

250ml fluid bolus, 10ml 10% calcium gluconate, 10U insulin + 50ml 50% dextrose +- NEB SABA

Question 36

what does calcium gluconate do for hyperkalaemia management

Answer 36

stabilises myocardium

Question 37

what does insulin do for hyperkalaemia management

Answer 37

moves K into cell

Question 38

what additional drug can be given in hyperkalaemia management if the patient is acidotic

Answer 38

sodium bicarbonate

Question 39

which of the following drugs are risk factors for hyperkalaemia - spironolactone - ramipril - furosemide - bendoflumethiaze - digoxin - atenolol - amiloride - trimethoprim

Answer 39

``` spironolactone ramipril amiloride atenolol trimethoprim ```

Question 40

how to calculate fluid requirements

Answer 40

25-30 per kg per dag

Question 41

what are the 3 types of intravenous fluid

Answer 41

crystalloids colloids blood products

Question 42

how are crystalloids categorised

Answer 42

balanced and unbalanced

Question 43

give an example of a balanced crystalloid

Answer 43

Hartman's

Question 44

give an example of an ubalanced crystalloid

Answer 44

0.9% NaCl, 4% NaCl

Question 45

what is the preferred fluid in acute resus

Answer 45

balanced crystalloid hartmann's

Question 46

what is the preferred fluid in AKI/CKD resus

Answer 46

NaCl unbalanced crystalloid

Question 47

what is a side effect of unbalanced crystalloid NaCl

Answer 47

hyperchloremic metabolic acidosis

Question 48

what fluid is used for routine maintenance

Answer 48

4% NaCl

Question 49

what fluid is used for resus in septic shock

Answer 49

4.5% human albumin colloid

Question 50

what fluid is used following paracentesis

Answer 50

20% hyperoncotic human albumin colloid

Question 51

side effect of colloids

Answer 51

anaphylaxis

Question 52

what is used in major haemorrhages

Answer 52

4U packed red cells + 1U platelets + 4U fresh frozen plasma

Question 53

side effect of blood products and how to prevent this

Answer 53

transfusion reaction, crossmatch