Acute Kidney Injury Flashcards

1
Q

Define Acute Kidney Injury (AKI)

A

Sudden, often REVERSIBLE loss of function. Developed within days/weeks. Accompanied by reduction in urine volume. Rapid loss of glomerular filtration & tubular function over days.

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2
Q

What are the three subtypes of AKI?

A

Pre-Renal (Most common)

Renal (Rare)

Post-Renal (Common and usually curable)

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3
Q

What is pre-renal AKI?

A
  • Perfusion to the kidney is reduced
  • Reduced perfusion = decreased GFR
  • Uncorrected, can lead to Acute Tubular Necrosis
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4
Q

What can cause reduced perfusion to kidney?

A
  • Congestive heart failure
  • Sepsis
  • Blood Loss (acute setting such as burns)
  • Dehydration
  • Vascular Occlusion
  • ARB/Diuretic Usage
  • NSAID / ACEi Usage
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5
Q

What histological findings would you see in pre-renal AKI?

A

Inflammatory changes

Interstitial Oedema

Focal breaks in tubular basement membrane

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6
Q

Symptoms of pre-renal AKI?

A
  • Vomiting
  • Diarrhoea
  • Haemorrhage
  • Jaundice
  • Postural hypotension
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7
Q

Signs of pre-renal AKI

A
  • Hypotension
  • Tachycardia
  • Weight Loss
  • Incr. skin turgor
  • Delayed capillary refill
  • JVP not visible
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8
Q

What is Renal AKI?

A
  • Primary insult that directly affects kidney function i.e. glomerulonephritis or nephrotic drugs or inflammatory disease/infection.
  • Untreated pre-renal AKI can cause Acute Tubular Necrosis which is a direct insult to kidney.
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9
Q

Signs of Renal AKI

A
  • Hypertension
  • Oedema
  • Purpuric rash (suggesting glomerulonephritis)
  • Fever/rash (suggesting interstitial nephritis)
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10
Q

What drugs can cause Renal AKI?

A

PPI

NSAIDs

Antibiotics

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11
Q

What is Post-renal AKI?

A

Obstruction of urine flow from ureter/tubule to urethra.

This causes in intraluminal uretal pressure, which can in turn affet nephron pressure.

If obstruction is not relieved, Angiotensin II will maintain the low GFR

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12
Q

What can cause a obstructed outflow from tubules?

A
  • Urinary calculi
  • Retroperitoneal fibrosis
  • BPE
  • Bladder cancer
  • Prostate cancer
  • Urethral stricture
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13
Q

What is the main sign of post-renal AKI?

A

Distended bladder.

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14
Q

What investigations do we do for AKI?

A

• Bloods:

  • U & Es
  • FBC
  • Bicarbonate
  • IgA
  • ABG
  • CREATININE (Diagnostic)

• Urinalysis

  • Dipstick (looking for blood and protein)
  • PCR
  • Ultrasound
  • Renal Biopsy
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15
Q

Management of AKI

A

STOP Protocol

S - Sepsis management

T - Toxin stoppage

O - Optimisation of BP (we just love acronyms init)

P - Prevent harm

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16
Q

What is the normal intake/output of fluids for a person?

A

In: 2500ml

Out: 2100-2600ml