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Renal > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

describe mortality in AKI

A

predicted by its duration
increased risk with increase in creatinine
severe AKI can have mortality up to 50-80% in context of multi-organ failure requiring renal replacement therapy

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2
Q

cost implications of AKI?

A

extra 4.7 days in hospital

higher costs than breast, lung and skin cancer combined

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3
Q

definition of AKI?

A

an abrupt (<48 hrs) reduction in kidney function defined as

  • absolute increase in serum creatinine by >26.4
  • or increase in creatinine by >50%
  • reduction in urine output
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4
Q

stage 1 AKI?

A

increase in creatinine > 26
or
increase > 1.5-1.9 X reference creatinine
urine output <0.5 ml/kg/hr for >6 consecutive hours

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5
Q

stage 2 AKI?

A

increase >2-2.9 X reference serum creatinine

urine output <0.5ml/kg/hr for >12 hrs

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6
Q

stage 3 AKI?

A 
increase >3 X reference serum creatinine
or
increase to >354
or
need for renal replacement therapy
urine output <0.3ml/kg/hr for >24 hrs or 12 hrs for anuria
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7
Q

risk factors for AKI?

A 
old age
CKD
diabetes
cardiac failure
liver disease
PVD
previous AKI
gentamicin
hypotension/hypovolaemia
sepsis
deteriorating NEWS
recent radiological contrast
drugs
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8
Q

3 groups of AKI?

A 
pre-renal (functional)
renal (structural)
post renal (obstruction)
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9
Q

3 causes of pre-renal AKI?

A

hypovolaemia (haemorrhage, volume depletion - D&V, burns etc)
hypotension (cardiogenic shock, distributive shock - sepsis, anaphylaxis etc)
renal hypoperfusion (NSAIDs, COX-2, ACE/ARBs, hepatorenal syndrome)

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10
Q

how does pre renal AKI affect urine output?

A

reversible volume depletion leading to oliguria and increase in creatinine
- oliguria = <0.5ml/kg/hr

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11
Q

risk of antihypertensives in AKI?

A

reduce blood pressure and therefore reduce renal perfusion
if combined with e.g vomiting and diarrhoea which reduced blood volume further, can cause major drop in renal perfusion leading to major fall in GFR

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12
Q

perfusion requirements of kidneys?

A

receive 20-25% of whole cardiac output

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13
Q

untreated pre-renal AKI can lead to what?

A

acute tubular necrosis

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14
Q

what is acute tubular necrosis?

A

commonest form of AKI in hospital

due to combination of factors leading to decreased renal perfusion

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15
Q

what can cause acute tubular necrosis?

A

sepsis
severe dehydration
rhabdomyolysis
drug toxicity

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16
Q

how is pre-renal AKI assessed for hydration?

A

clinical observation
JVP, cap refill, oedema
pulmonary oedema

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17
Q

how is fluid given in pre-renal AKI?

A

crystalloid (0.9% NaCl) or colloid (gelofusin)
DO NOT USE DEXTROSE
give bolus of fluid then reassess and repeat as necessary
if >1 L has been given with no improvement, seek help

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18
Q

categories of renal AKI?

A 
divided by structure affected:
blood vessels
glomerular disease
interstitial injury
tubular injury
19
Q

vascular causes of renal AKI?

A

vasculitis

renovascular disease

20
Q

glomerular causes of AKI?

A

glomerulonephritis

21
Q

interstitial causes of AKI (interstitial nephritis)?

A

drugs
- NSAIDs, PPIs, penicillin, gentamicin
infection (TB)
systemic (sarcoidosis)

22
Q

what can cause tubular injury AKI?

A

ischaemia
drugs (gentamicin)
contrast
rhabdomylolysis

23
Q

symptoms and signs of AKI?

A

constitutional (weight loss, fatigue, lethargy)
nausea and vomiting
itch
fluid overload (oedema, breathless, pulmonary oedema, hypertension, effusions)
uraemia (including itch, pericarditis etc)
oliguria

24
Q

examples of history which can point to cause of AKI?

A 
sore throat - strep
rash - vasculitis
joint pains - vasculitis
D&amp;V - 
haemoptysis - ANCA associated vasculitis, goodpastures
25
Q

eosinophllia on blood results can indicate what causes of AKI?

A

churg strauss

interstitial nephritis

26
Q

initial investigations in AKI?

A

Us&Es (marker of renal function - Na, K, Ur, Cr)
FBC and coagulation screen (anaemia, clotting - deranged in sepsis)
urinalysis (haematoproteinuria indicates renal cause rather than pre-renal)
US (small size = chronic kidney disease, not acute)
immunology (ANA - lupus, ANCA - vasculitis, GBM - goodpastures)
protein electrophoresis and BJP

27
Q

further treatment of AKI?

A

establish perfusion pressure (fluid resuscitation, inotropes/vasopressors)
treat underlying cause (antibiotics for sepsis etc)
stop nephrotoxic drugs
dialysis if patient remains anuric and ureamic

28
Q

life threatening complications of AKI?

A 
hyperkalaemia
fluid overload (pulm oedema)
severe acidosis
uraemic pericardial effusion
severe uraemia
29
Q

what causes post-renal AKI?

A

obstruction

  • stones
  • cancers
  • strictures
  • extrinsic pressure
30
Q

how is post-renal AKI treated?

A

relieve obstruction
- catheter
- nephrostomy
refer to urology if stenting needed

31
Q

how does hyperkalemia present?

A

muscle weakness

arrhythmias

32
Q

levels of hyperkalaemia?

A

normal = 3.5-5
hyperkalaemia = >5.5
life threatening = >6.5

33
Q

possible ECG findings in severe hyperkalemia?

A

tall T waves
slow rhythm
absent P waves
wide QRS

34
Q

how is hyperkalaemia managed?

A

cardiac monitor
protect myocardium = 10mls 10% calcium gluconate for 2-3 mins
move K+ back into cells = insulin (10 units) with 50mls 50% dextrose (30 mins), salbutamol nebuliser (90 mins)
prevent absorption from GI tract ( calcium resonium - not in the acute setting)

35
Q

how is bicarbonate related to hyperkalaemia?

A

low bicarbonate = metabolic acidosis
metabolic acidosis can exacerbate hyperkalaemia
treated with sodium bicarbonate

36
Q

4 urgent indications for haemodialysis?

A

hyperkalaemia (>7 or >6.5 and unresponsive to medical therapy)
severe acidosis (pH <7.15)
fluid overload
urea >40, pericardial rub/effusion

37
Q

1.40 year old male presenting with general malaise & haemoptysis (Urea 28, Creatinine 600, elevated ant-GBM)?

A

goodpastures

38
Q

25 year old IVDA found collapsed at home

A

rhabdomyolysis

39
Q

. 82 year old man admitted with BP 70 30, T 39, pulse 140bpm, K+ 7.0, urea 48, Cr 789, CRP 250, CXR left basal consolidation

A

sepsis

40
Q

72 year old man presenting with difficulty passing urine and reduced urine output

A

obstructive

41
Q 
which of the following drugs does not cause hyperkalaemia?
spironolactone
Ramipril
amiloride
furosemide
atenolol
A

furosemide

42
Q

80 year old male admitted with 4-5 day history of diarrhoea. On admission BP 80 40, pulse 30bpm. Bloods phone back: Na 135, K+ 8.0, Urea 50, Cr 1000, Bicarb 9
Which of the following drugs would you administer first?
A. insulin/dextrose
B. Sodium Bicarbonate
C. Salbutamol nebuliser
D. Calcium Resonium
E. Calcium Gluconate

A

calcium gluconate

43
Q

why is trimethoprim avoided in AKI?

A

it causes hyperkalaemia and causes increase in creatinine

Renal (34 decks)

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