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Urogenital 2 > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

What is AKI?

A

Abrupt deterioration in renal function, usually over hours/days. Results in a failure to maintain fluid, electrolyte and acid-base balance.

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2
Q

What is pre-renal AKI?

A

Decreased renal perfusion pressure

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3
Q

What is intrinsic renal AKI?

A

Pathology of the vessels, glomeruli, or tubules-interstitium.

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4
Q

What is post-renal AKI?

A

Obstruction of urinary outflow.

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5
Q

What can causes the impaired perfusion in pre-renal AKI?

A 
Cardiac failure
Sepsis 
Blood loss 
Dehydration
Vascular occlusion
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6
Q

What can cause glomerulonephritis, small-vessel vasculitis and acute tubular necrosis in intrinsic renal AKI?

A

Drugs
Toxins
Prolonged hypertension

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7
Q

What can cause Interstitial nephritis in intrinsic renal AKI?

A

Drugs
Toxins
Inflammatory disease
Infection

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8
Q

What can cause obstruction of urinary flow in post-renal AKI?

A 
Retroperitoneal fibrosis
Benign prostatic enlargement
Bladder cancer
Prostate cancer 
Cervical cancer
Urethral structure/valves
Meatal stenosis
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9
Q

Define meatal stenosis.

A

Meatal stenosis is an abnormal narrowing of the urethral opening (meatus).

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10
Q

Define oliguria?

A

Decreased urine output (<400ml/day)

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11
Q

What is the most common underlying pathophysiological cause of AKI?

A

Acute tubular necrosis

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12
Q

What causes acute tubular necrosis?

A

Under perfusion and reduced renal blood flow with intrarenal microvascular vasoconstriction leads to a decrease in the delivery of O2 increasing tubular hypoxia, leading to tubular necrosis.

Can also be caused by nephrotoxic drugs.

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13
Q

Why is acute tubular necrosis reversible?

A

Tubular cells have the ability to regenerate rapidly and to reform the disrupted tubular basement membrane - which is why ATN is reversible.

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14
Q

What are the 3 types of tubular renal AKI?

A

Acute tubular necrosis
Acute interstitial nephritis
Myeloma / Tumourlysis / Rhabdomyolysis

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15
Q

What can cause acute interstitial nephritis?

A

Allergic reaction - drug related

Can also be caused by infection e.g UTI

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16
Q

How do you test of post-renal obsturction of the urinary tract?

A

Ultrasound scan.

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17
Q

Pruritis

A

Severe itching of the skin

18
Q

What is the major respiratory complication of AKI?

A

Shortness of breath due to pulmonary oedema.

19
Q

How is GFR affected in post renal AKI?

A

Postrenal failure is caused by obstruction of the urinary tract, leading to increased intratubular pressure and a fall in GFR.

20
Q

What can cause intratubular obstruction in intrinsic AKI?

A

Blockage of the tubules by protein (rhabdomyolysis and myeloma).

21
Q

What can urine biochemistry help identify in investigation?

A

Whether the AKI is renal or pre-renal.

22
Q

Why is an ultrasound carried out in cases of AKI?

A

To exclude post-renal obstruction.

23
Q

What are the two major concerns of AKI?

A

Hypovolaemia and hyperkalaemia.

24
Q

Hyperkalaemia

A

High potassium

25
Q

Hypernatremia

A

High sodium

26
Q

Interstitial nephritis is what type of AKI?

A

Intrarenal

27
Q

Interstitial nephritis is usually caused by what?

A

Type 1 or Type IV hypersensitivity reaction caused by drugs such as NSAID’s, Diuretics or penicillin.

28
Q

What is renal artery stenosis?

A

The narrowing of one or both renal arteries.

29
Q

What can cause renal artery stenosis?

A

Atherosclerosis

Fibromuscular dyplasia

30
Q

Fibromuscular dysplasia

A

Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory disease of the blood vessels that causes abnormal growth within the wall of an artery.

31
Q

Post renal AKI

A

Due to obstruction of urine from the kidneys leading to a build up of pressure and urine.

32
Q

Name two nephrotoxic drugs that can cause intrarenal aki.

A

NSAIDS

ACE inhibitors

33
Q

Why does aki cause pulmonary oedema?

A

As the kidneys are unable to filter blood, there is a build up of fluid hypervolemia. Which leads to leakage of fluid into the lung causing pulmonary oedema.

34
Q

Nephrotoxic syndrome

A

Nephrotic syndrome is a kidney disorder that causes your body to pass too much protein in your urine. Nephrotic syndrome is usually caused by damage to the glomerular capillaries.

35
Q

What is the triad of symptoms seen in nephrotoxic syndrome?

A

Oedema
Proteinuria
Low albumin levels in the blood

36
Q

What is the major complication of nephrotoxic syndrome?

A

Oedema

37
Q

How does nephrotoxic syndrome increase the risk of clotting?

A

Nephrotic syndrome increases the amount of anti-thrombin III lost in the urine.
Due to decreased protein in the blood the liver also activates protein synthesis increasing the number of clotting factors produced.

38
Q

NICE Criteria for AKI:

A

Rise in creatinine of ≥ 25 micromol/L in 48 hours
Rise in creatinine of ≥ 50% in 7 days
Urine output of < 0.5ml/kg/hour for > 6 hours

39
Q

Risk factors for AKI:

A

Consider the possibility of an acute kidney injury in patients that are suffering with an acute illness such as infection or having a surgical operation. Risk factors that would predispose them to developing acute kidney injury include:
CONTRAST CT
ACE inhibitors / NSAIDS both nephrotoxic
usual risk factors for everything…

40
Q

Whenever someone asks you the cause of renal impairment always answer “the causes are pre-renal, renal or post-renal”. This will impress them and allow you to think through the causes more logically.

A

Whenever someone asks you the cause of renal impairment always answer “the causes are pre-renal, renal or post-renal”. This will impress them and allow you to think through the causes more logically.

41
Q

Treatment of AKI:

A

Fluid rehydration with IV fluids in pre-renal AKI.
Stop nephrotoxic medications such as NSAIDS and antihypertensives that reduce the filtration pressure (i.e. ACE inhibitors).
Relieve obstruction in a post-renal AKI, for example insert a catheter for a patient in retention from an enlarged prostate.

42
Q

What are the complications:

A

Hyperkalaemia
Fluid overload, heart failure and pulmonary oedema
Metabolic acidosis
Uraemia (high urea) can lead to encephalopathy or pericarditis.

Urogenital 2 (22 decks)

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