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Renal > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

Define acute kidney injury

A

An abrupt (<48hours) reduction in kidney function defined as;

  • an absolute increase in serum creatinine by >26.4
  • increase in serum creatinine by >50%
  • reduction in urinary output
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2
Q

Describe stage 1 AKI

A

Serum creatinine - >26 or >1.5-1.9 times the reference baseline creatinine
Urine output <0.5ml/kg/hour for >6 hours

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3
Q

Describe stage 2 AKI

A

Serum creatinine >2-2.9 times the reference

Urine output <0.5ml/kg/hour for >12 hours

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4
Q

Describe stage 3 AKI

A

Increased creatinine >3 times reference or >354 or need for RRT
Urine output <0.3ml/kg/hour for >24 horus or 12 hours of anuria

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5
Q

State the risk factors for AKI

A
  • Older age
  • CKD
  • Liver Disease
  • PVD
  • Diabetes
  • Previous AKI
  • Cardiac Failure
  • Hypotension/hypovolaemia
  • Sepsis
  • Recent contrast
  • Deteriorating NEWS
  • Medications
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6
Q

What are the pre-renal causes of AKI?

A

Hypovolaemia
Hypotension
Hyperfusion

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7
Q

What causes hypovolaemia leading to AKI?

A

Haemorrhage

Volume depletion through burns or diarrhoea/vomitting

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8
Q

What causes hypotension leading to AKI?

A

MI - cardiogenic shock

Distributive shock - sepsis or anaphylaxis

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9
Q

What causes hypo-perfusion leading to AKI?

A

NSAIDs, COX2 inhibitors, ACEi, ARB, hepatorenal syndrome

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10
Q

State normal urine output

A

0.5ml/kg/hour

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11
Q

Define oliguria

A

<0.5ml/kg/hour

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12
Q

If decreased perfusion occurs how does the body normally cope?

A

Renin is released and this causes angiotensin II to cause vasoconstriction and GFR is maintained

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13
Q

How do ACEi impact the body’s ability to compensate for hypo-perfusion?

A

ACEi reduce angiotensin II which leads to a reduced GFR which is normal ok but if the patient loses a significant amount of fluid there will be a major fall in GFR

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14
Q

If left untreated what can pre-renal AKI lead to?

A

Acute Tubular Necrosis

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15
Q

What is the treatment for pre-renal AKI?

A

Assess hydration - BP, HR, JVP, Cap refil, oedema

Fluid challenge - 0.9% NaCl if no improvement after 1000ml then get help

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16
Q

What causes renal AKI?

A

Small Vessel Vasculitis
Glomerulonephritis
Interstitial Nephritis
Tubular Injury

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17
Q

What causes interstitial nephritis?

A

Drugs - antibiotics, PPIs, NSAIDs
Infection -TB
Systemic disease - sarcoidosis

18
Q

What causes tubular injury?

A

Ischaemia, drugs, contrast, rhabdomylosis

19
Q

Describe rhabdomyolosis

A

Breakdown of damaged skeletal muscles leading to the release of myoglobin in the blood

20
Q

What are the signs/symptoms of renal AKI?

A

Nausea/vomiting, fluid overload, itch, constitutional symptoms, hypertension, effusions, oliguria, uraemia

21
Q

Name some clues that might help to diagnose renal AKI

A
  • signs of infection/systemic disease
  • drug chart
  • urinalysis
  • recent contrast
  • blood results
  • vascular bruits
22
Q

What are vascular bruits a sign of?

A

Renal Artery Stenosis

23
Q

What investigations are carried out in AKI?

A

U and E - particularly potassium
FBC and coagulation - HUS, disseminated clotting
Urinalysis - glomerulonephritis/vasculitis
USS - size/obstruction
Immunology
Protein electrophoresis and BJP -myeloma >50yo

24
Q

How is renal AKI treated?

A

Establish good perfusion with fluid
Inotropes/vasopressors
Treat underlying cause
Stop nephrotoxic drugs

25
Q

What are the complications of renal AKI?

A

Hyperkalaemia, fluid overload, severe acidosis , uraemia pericardial effusion, severe uraemia

26
Q

What causes post renal AKI?

A

Obstruction of urine flow leading to back pressure - hydronephrosis and loss of concentrating ability

27
Q

What can obstruct the urine flow?

A

Stones, cancer, strictures, extrinsic pressure

28
Q

How is post renal AKI diagnosed?

A

US and CT show dilated renal pelvis

29
Q

How is post renal AKI treated?

A

Catheter and nephrostomy, refer to urology

30
Q

State the values for normal, hyperkalaemia and life threatening potassium levels

A

Normal <3.5-5
Hyperkalaemia >5.5
Life threatening >6.5

31
Q

What are the effects of increased potassium?

A

Cardiac arrhythmia and muscle weakness/tingling

32
Q

What are the key signs of hyperkalaemia on ECG?

A

Peaked T waves, prolonged QRS, eventually becomes a sine wave and can lead to VT/VF

33
Q

How is hyperkalaemia treated?

A

Protect myocardium - calcium gluconate 10mls 10%
Move potassium back into cells - insulin with dextrose and salbutamol nebuliser
Prevent GI absorption (not in acute setting) - calcium resonium

34
Q

What indicates urgent haemodialysis?

A

Acidosis
Electrolyte disturbance (potassium >7 or >6.5 and unresponsive to treatment)
Intoxication
Overload of volume (not passing urine or response to diuretics)
Uraemia >40, pericardial rub or effusion

35
Q

What causes acute tubular necrosis?

A

Ischaemia
Nephrotoxins
Sepsis

36
Q

What will be present in the urine of patients with acute tubular necrosis?

A

Muddy brown casts due to necrotic epithelium

High urinary sodium

37
Q

How will interstitial nephritis present?

A

Temperature, rash, eosinophilia, white cell casts

38
Q

How is interstitial nephritis treated?

A

Prednisolone

39
Q

What drugs must be stopped in AKI?

A

NSAIDs
ACEi/ARB
Diuretics
Aminoglycosides

40
Q

What drugs should you consider stopping in AKI?

A

Metformin
Lithium
Digoxin

Renal (20 decks)

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