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Nephrology and Urology > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

Acute kidney injury is usually due to a kidney pathology. T/F?

A

False - it is usually caused by problems elsewhere in the body, but can be caused by renal pathology

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2
Q

AKI is usually reversible. T/F?

A

True

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3
Q

eGFR is a useful marker in acute kidney injury. T/F?

A

False

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4
Q

What should be used instead go eGFR as a measure of kidney function in acute kidney injury?

A

Serum creatinine

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5
Q

Describe stage one acute kidney injury

A

Serum creatinine >1.5 and <2.0 times AKI baseline or >26micromol/l increased above AKI baseline

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6
Q

Describe stage two acute kidney injury

A

Serum creatinine >2.0 but <3.0 times AKI baseline

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7
Q

Describe stage three acute kidney injury

A

Serum creatinine >3.5 times AKI baseline or >345micromol/l increase above AKI baseline

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8
Q

How is oliguria defined in infants?

A

<1ml/kg/hour of urine output

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9
Q

How is oliguria defined in children?

A

<0.5ml/kg/h urine output

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10
Q

How is oliguria defined in adults?

A

<400-500ml urine output per 24 hours

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11
Q

Non-oliguric acute kidney injury is easier to manage. T/F?

A

True

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12
Q

Laboratories automatically compare the patient’s creatinine to their previous creatinine measurements to alert clinicians to possible acute kidney injury. T/F?

A

True

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13
Q

Give examples of pre-renal causes of acute kidney injury

A 
Hypovolaemia (burns, diarrhoea, haemorrhage)
Hypotension
Septic shock
Cardiac failure
Cirrhosis
ACE inhibitors
NSAIDs
Renal artery stenosis
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14
Q

Give examples of renal causes of acute kidney injury

A 
Glomerulonephritis
Ischaemic acute tubule necrosis
Nephrottoxic acute tubule necrosis
Myeloma
Rhabdomyolysis 
Drugs - gentamicin
Sarcoid
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15
Q

Give examples of post renal causes of acute kidney injury

A 
Renal papillary necrosis
Kidney stones
Retroperitoneal fibrosis
Carcinoma of the cervix
Prostatic hypertrophy/malignancy
Urethral strictures
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16
Q

‘Renal’ acute kidney injury can often result from injury to the kidneys due to untreated pre renal acute kidney injury. T/F?

A

True

17
Q

What test is used to exclude obstructive causes of acute kidney injury?

A

Ultrasound

18
Q

What site is the common cause of obstruction leading to a cute kidney injury in men?

A

Prostate

19
Q

Give examples of toxins which can cause renal acute kidney injury

A 
Drugs - NSAIDs, ACE inhibitors, gentamicin
Contrast agents
Poisons - metals, antifreeze
Myoglobin
Haemoglobin
Immunoglobulins
Calcium
Urate
20
Q

Explain how NSAIDs can cause acute kidney injury

A

As glomerular pressure falls towards 80mmHg, prostaglandins dilate the afferent arteriole to increase flow. NSAIDs inhibit these prostaglandins and so can cause hypo perfusion

21
Q

Explain how ACE inhibitors can cause acute kidney injury

A

ACE inhibitors prevent constriction of the efferent arteriole which decreases glomerular pressure. If glomerular pressure falls too low this can cause hypo perfusion

22
Q

List the investigations which should be conducted in acute kidney injury

A 
Serum creatinine, urea and potassium
Urinalysis
Measure urine output
Renal ultrasound
Cardiovascular examination
Glomerulonephritis screen (ANCA, ANA, immunoglobulins, complement antiGBM, bence jones protein)
Blood films
LDH
Creatinine kinase
23
Q

What finding on ultrasound suggests CKD?

A

Loss of cortical medullary differentiation

24
Q

Hyperkalaemia of what level is a risk of arrhythmia and requires treatment?

A

> 6

25
Q

Hyperkalaemia of what level is a medical emergency?

A

> 6.5

26
Q

How is hyperkalaemia in acute kidney injury treated?

A

15g calcium resonium 4x daily orally to reduce calcium absorption from gut
10-15 units act rapid insulin + 50ml 50% dextrose to move potassium into cells
10ml 10% calcium gluconate as a cardiac membrane stabiliser
Iv NaBicarb 1.26% if bicarbonate is <16

27
Q

When might dialysis be required in acute kidney injury?

A

Refractory hyperkalaemia >6.5mmol/l

Refractory pulmonary oedema

28
Q

Give examples of toxins which require dialysis for removal?

A

Lithium

Ethylene glycol

29
Q

What is the outcome of patients with acute kidney injury?

A

Those who are dialysed have a 20-30% mortality
85% return to baseline kidney fucntion
10% left with some form of renal impairment
5% do not recover kidney function

30
Q

In recovery from acute kidney injury the tubules fail to concentrate urine and there can be low potassium, calcium and magnesium. T/F?

A

True

Nephrology and Urology (13 decks)

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