Acute Kidney Injury Flashcards

1
Q

how quickly does an AKI occur

A

in <48hr

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2
Q

which drugs are risk factors for AKI

A

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

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3
Q

what is a stage 1 AKI

A

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

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4
Q

what is a stage 2 AKI

A

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

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5
Q

what is a stage 3 AKI

A
Cr>3X baseline or >354 
or 
need RRT 
or 
UO <0.3/hr for >12hr
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6
Q

how are the causes of AKI classified

A

pre-renal, renal, post-renal

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7
Q

causes of pre-renal AKI

A

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

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8
Q

causes of renal AKI

A

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

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9
Q

causes of acute tubular necrosis

A

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

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10
Q

what drugs can cause acute tubular necrosis

A

NSAID, ACEI, contrast, genta

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11
Q

causes of acute interstitial nephritis

A

TB, SLE, sarcoid, drugs, pyelonephritis

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12
Q

what drugs can cause acute interstitial nephritis

A

PPI, fluclox hypersensitivity, NSAID

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13
Q

causes of post-renal AKI

A

obstruction e.g. stircture, tumour, stone

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14
Q

what types of shock can cause pre-renal AKI

A

distributive, cardiogenic

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15
Q

what electrolyte disturbance is caused by rhabdomyolysis

A

hyperkalaemia

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16
Q

what is the 1st thing to do in suspected AKI

A

stop nephrotoxic drugs, diuretics, and antihypertensives

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17
Q

investigations for AKI

A

bloods, urinalysis, US kidney

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18
Q

what blood tests for AKI

A

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

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19
Q

what tests should you do if urinalysis is positive

A

ANA, ANCA, complement, UPCR

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20
Q

what can you get from renal US in AKI

A

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

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21
Q

what are the red flags for myeloma

A

> 50 yr + anaemia + hypercalcaemia

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22
Q

what test should you do additionally if you suspect myeloma

A

bence jones protein

23
Q

what test should you do if immunology is positive

A

biopsy

24
Q

what are the contraindications to biopsy

A

taking warfarin/aspirin

25
Q

what is the 1st treatment step in AKI

A

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

26
Q

what drugs should you give for AKI if BP is down

A

inotrope / vasopressor

27
Q

management of post-renal AKI

A

catheter or nephrostomy

28
Q

when is haemodialysis indicated for AKI

A

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

29
Q

management of AKI if suspected vasculitis

A

IV CCS (+- later cyclophosphamide, TPE)

30
Q

commonest complication of AKI

A

hyperkalaemia

31
Q

presentation of >K

A

cardiac arrhythmia, muscle weakness

32
Q

what is hyperkalaemia levels

A

> 5.5

33
Q

what are life threatening hyperkalaemia levels

A

> 6.5

34
Q

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

A

tall T waves, decreased HR, broad QRS

35
Q

management of hyperkalaemia

A

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

36
Q

what does calcium gluconate do for hyperkalaemia management

A

stabilises myocardium

37
Q

what does insulin do for hyperkalaemia management

A

moves K into cell

38
Q

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

A

sodium bicarbonate

39
Q

which of the following drugs are risk factors for hyperkalaemia

  • spironolactone
  • ramipril
  • furosemide
  • bendoflumethiaze
  • digoxin
  • atenolol
  • amiloride
  • trimethoprim
A
spironolactone
ramipril
amiloride
atenolol
trimethoprim
40
Q

how to calculate fluid requirements

A

25-30 per kg per dag

41
Q

what are the 3 types of intravenous fluid

A

crystalloids
colloids
blood products

42
Q

how are crystalloids categorised

A

balanced and unbalanced

43
Q

give an example of a balanced crystalloid

A

Hartman’s

44
Q

give an example of an ubalanced crystalloid

A

0.9% NaCl, 4% NaCl

45
Q

what is the preferred fluid in acute resus

A

balanced crystalloid hartmann’s

46
Q

what is the preferred fluid in AKI/CKD resus

A

NaCl unbalanced crystalloid

47
Q

what is a side effect of unbalanced crystalloid NaCl

A

hyperchloremic metabolic acidosis

48
Q

what fluid is used for routine maintenance

A

4% NaCl

49
Q

what fluid is used for resus in septic shock

A

4.5% human albumin colloid

50
Q

what fluid is used following paracentesis

A

20% hyperoncotic human albumin colloid

51
Q

side effect of colloids

A

anaphylaxis

52
Q

what is used in major haemorrhages

A

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

53
Q

side effect of blood products and how to prevent this

A

transfusion reaction, crossmatch