Acute Kidney injury Flashcards
Give 5 functions of the kidney
regulation of red blood cells regulation of blood pressure influence of blood ph and acid base excretion of metabolic waste and water regulation of bone mineral metabolism
define acute kidney injury
rapid reduction in kidney function
occurs over hours to days
what is AKI based on
rises in creatinine and decreases in urine output
how many stages of AKI are there
3
what is AKI associated with
increased:
morbidity
mortality
risk of chronic kidney disease
what percentage of hospital admissions and icu admission are due to AKI
18%
30-80%
what are some risk factors of AKI
over 75 pre-existing CKD dementia DM HF hypotension sepsis hypovolaemia
describe the clinical presentation of acutely ill/ post major surgery AKI
hypovolaemia / hypotensive
sepsis
describe the clinical presentation of AKI due to poor fluid intake
nausea, vomiting
decreased urine output
AKI in association with excessive fluid losses can be caused by what
fever diuretics diarrhoea high stoma output burns
what are some complications of aki
hyperkalaemia - cardia arrest acidaemia pul oedema uraemia - pericarditis, encephalopathy GIT - gastritis, malnutrition haemorrhage and anaemia
what are some investigations you can do to asses kidney function
full blood count U&E's and bicarbonate C-reactive protein liver function urinalysis
define the kidney functional reserve
50% loss of function before serum creatinine raises above the upper limit of normal
what can ultrasound be used to assessed for in AKI
obstruction
what does STOP stand for
sepsis
toxins
optimise (blood pressure and volume)
prevent harm
if someone comes in with AKI due to high creatinine and taking ramipril and fureosomide why should you stop
both these drugs reduce blood volume and pressure so you should stop taking the drugs
what are the two rarer forms of AKI
post-renal - obstruction intrinsic : ANCA associated vasculitis lupus nephritis myeloma
what would happen on an ECG of someone with AKI
loss of P wave and tented (peak) of T wave due to hyperkalaemia
how do you treat hyperkalaemia
30 mls 10% Ca gluconate over 5/10 mins
50 mls 50% glucose + 10 units insulin
stop drugs increasing K levels
salbutamol nebulisers
renal replacement therapy
how would you treat pulmonary oedema
sit up O2 high flow mask via reservoir mask high dose furosemide intravenous nitrates renal replacement therapy
in AKI you have reduced drug clearance - what is the risk of these drugs penecillin morphine metformin digoxin
seizures
respiratory depression
lactic acidosis
cardiac toxicity
what drugs can cause nephrotoxicity
ahminoglycosides - gentamicin
NSAIDS - voltarol ibuprofen
what are the indications of renal replacement therapy
hyperkalaemia unresponsive to medical treatment
pul oedema unresponsive
severe anaemia ph higher than 7.1
encephalopathy or pericarditis
describe intermittent RRT
indicated for patients who are haemodynamically stable via haemodialyssi and peritoneal dialysis
describe continuous RRT
for those who are haemodynamically unstable
continuous vino-venous haemodialysis
what are complications of benign hyperplasia of the prostate
enlarged prostate projects in to bladder
impedes urination by distorting prostatic urethrea
nocturne, dysuria urgency
describe the neuronal control of filling in the bladder
stretch receptors of the bladder from T10-L2 (relaxation)
internal urethral is the same (contraction)
external sphincter controlled by somatic NS - pudenal nerve (contraction)
describe the neuronal control of emptying in the bladder
contraction of bladder from para symp - S2-S4
relaxation of internal urethra (para) S2-S4
relaxation of internal urethral sphincter - somatic - pudendal nerve
