Acute Kidney Injury Flashcards
What can AKI lead to ?
Chronic Kidney Disease
Define ARF?
Acute Renal Failure
- rapid loss of glomerular filtration and tubular function over hours to days
- retention of urea/creatinine
- potentially recoverable
What are the immediate dangerous consequences of AKI?
Acidosis Electrolyte Imbalance Intoxication (TOXINS) Overload (FLUID) Uraemic Complications
= ALL CAN LEAD TO CARDIAC ARREST
What are the prerenal causes of AKI?
problems with blood flow to kidney
Sepsis, hypovolaemia, hepatorenal syndrome, cardiac failure, hypotension
What are the renal causes of AKI?
Damage to renal parenchyma
Nephrotoxins, tubulointerstitial injury, glomerulonephritis, myeloma, vasculitis
What are the post-renal causes of AKI?
Obstruction to urine exit
Kidney stones, prostatic hypertrophy, tumours
Why is the kidney susceptible to hypoperfusion?
Intrarenal heterogenetity of blood supply, oxygenation, metabolic demand
When does post-obstructive natriuresis occur?
When GFR recovers quicker than tubule resorptive capacity
What is the course of tubular necrosis and its recovery?
Initiation
- Exposure to ischaemic insults results in renal parenchymal injury (AKI potentially preventable)
Maintenance
- Injury established and may last for 1-2 weeks
Recovery
- Urine output increases gradually and creatinine levels fall
What is a common iatrogenic cause of AKI?
Radiocontrast agent
What are risk factors for RCN?
DM, renovascular disease, impaired renal function, paraprotein, high volume of radiocontrast
How does multiple myeloma present?
Anaemia, back pain, weight loss, fractures, infection, ESR raised, hypercalcaemia
How is multiple myeloma diagosed?
Bone marrow aspirate, serum paraprotein, BJP, skeletal survey
How does renal failure present in myeloma?
Light chain nephropathy, amyloidosis, hypercalcaemia, hyperuricaemia
What investigations should be done in AKI?
History, renal function, urine disptick, FBC, USS, Blood gas
