Acute Kidney injury

Question 1

Give 5 functions of the kidney

Answer 1

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

Question 2

define acute kidney injury

Answer 2

rapid reduction in kidney function

occurs over hours to days

Question 3

what is AKI based on

Answer 3

rises in creatinine and decreases in urine output

Question 4

how many stages of AKI are there

Answer 4

3

Question 5

what is AKI associated with

Answer 5

increased:
morbidity
mortality
risk of chronic kidney disease

Question 6

what percentage of hospital admissions and icu admission are due to AKI

Answer 6

18%

30-80%

Question 7

what are some risk factors of AKI

Answer 7

over 75 
pre-existing CKD
dementia 
DM
HF 
hypotension 
sepsis 
hypovolaemia

Question 8

describe the clinical presentation of acutely ill/ post major surgery AKI

Answer 8

hypovolaemia / hypotensive

sepsis

Question 9

describe the clinical presentation of AKI due to poor fluid intake

Answer 9

nausea, vomiting

decreased urine output

Question 10

AKI in association with excessive fluid losses can be caused by what

Answer 10

fever 
diuretics 
diarrhoea 
high stoma output 
burns

Question 11

what are some complications of aki

Answer 11

hyperkalaemia - cardia arrest 
acidaemia 
pul oedema 
uraemia - pericarditis, encephalopathy 
GIT - gastritis, malnutrition 
haemorrhage and anaemia

Question 12

what are some investigations you can do to asses kidney function

Answer 12

full blood count 
U&E's and bicarbonate 
C-reactive protein 
liver function 
urinalysis

Question 13

define the kidney functional reserve

Answer 13

50% loss of function before serum creatinine raises above the upper limit of normal

Question 14

what can ultrasound be used to assessed for in AKI

Answer 14

obstruction

Question 15

what does STOP stand for

Answer 15

sepsis
toxins
optimise (blood pressure and volume)
prevent harm

Question 16

if someone comes in with AKI due to high creatinine and taking ramipril and fureosomide why should you stop

Answer 16

both these drugs reduce blood volume and pressure so you should stop taking the drugs

Question 17

what are the two rarer forms of AKI

Answer 17

post-renal - obstruction 
intrinsic :
ANCA associated vasculitis 
lupus nephritis 
myeloma

Question 18

what would happen on an ECG of someone with AKI

Answer 18

loss of P wave and tented (peak) of T wave due to hyperkalaemia

Question 19

how do you treat hyperkalaemia

Answer 19

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

Question 20

how would you treat pulmonary oedema

Answer 20

sit up 
O2 high flow mask via reservoir mask 
high dose furosemide 
intravenous nitrates 
renal replacement therapy

Question 21

in AKI you have reduced drug clearance - what is the risk of these drugs 
penecillin
morphine
metformin 
digoxin

Answer 21

seizures
respiratory depression
lactic acidosis
cardiac toxicity

Question 22

what drugs can cause nephrotoxicity

Answer 22

ahminoglycosides - gentamicin

NSAIDS - voltarol ibuprofen

Question 23

what are the indications of renal replacement therapy

Answer 23

hyperkalaemia unresponsive to medical treatment
pul oedema unresponsive
severe anaemia ph higher than 7.1
encephalopathy or pericarditis

Question 24

describe intermittent RRT

Answer 24

indicated for patients who are haemodynamically stable via haemodialyssi and peritoneal dialysis

Question 25

describe continuous RRT

Answer 25

for those who are haemodynamically unstable

continuous vino-venous haemodialysis

Question 26

what are complications of benign hyperplasia of the prostate

Answer 26

enlarged prostate projects in to bladder
impedes urination by distorting prostatic urethrea
nocturne, dysuria urgency

Question 27

describe the neuronal control of filling in the bladder

Answer 27

stretch receptors of the bladder from T10-L2 (relaxation)
internal urethral is the same (contraction)
external sphincter controlled by somatic NS - pudenal nerve (contraction)

Question 28

describe the neuronal control of emptying in the bladder

Answer 28

contraction of bladder from para symp - S2-S4
relaxation of internal urethra (para) S2-S4
relaxation of internal urethral sphincter - somatic - pudendal nerve