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Gen Med (Renal) > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

An AKI is defined as a rapid reduction in kidney function over what period of time?

A

Hours - days

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2
Q

An AKI can be diagnosed if there is a rise in creatinine by more than what in a 48h period?

A

26micromol/litre

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3
Q

An AKI can be diagnosed if the creatinine level rises by more than what times the baseline level?

A

1.5 x baseline

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4
Q

A stage 1 AKI can be diagnosed if an individual’s urine output has been < 0.5ml/kg/hour for how long?

A

More than 6 consecutive hours

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5
Q

What is the staging system used for AKIs?

A

KDIGO staging

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6
Q

An increase in serum creatinine 1.5-1.9x baseline indicates which stage of AKI?

A

Stage 1

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7
Q

A stage 2 AKI can be diagnosed if an individual’s urine output has been < 0.5ml/kg/hour for how long?

A

More than 12 consecutive hours

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8
Q

What is the serum creatinine criteria for a stage 2 AKI?

A

Serum creatinine 2 - 2.9 x baseline

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9
Q

A stage 3 AKI can be diagnosed if serum creatinine is more than 3 x baseline value, or if the serum creatinine is greater than what value?

A

354micromol/litre

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10
Q

What is the urine output criteria for diagnosing a stage 3 AKI?

A

< 0.3ml/kg/hour for > 24 hours OR anuria for 12 hours

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11
Q

What other factor would indicate a stage 3 AKI, irrespective of the serum creatinine or urine output?

A

The need for RRT

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12
Q

What is the mechanism of a pre-renal AKI?

A

Renal hypoperfusion

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13
Q

What are some examples of pre-renal causes of an AKI?

A

Hypovolaemia, hypotension, sepsis

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14
Q

What is the mechanism of a post-renal AKI?

A

Urinary tract obstruction

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15
Q

What are some examples of post-renal causes of an AKI?

A

Tumours, stones, prostatic enlargement

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16
Q

Untreated pre-renal AKI can lead to what complication, causing a renal AKI?

A

Acute tubular necrosis

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17
Q

What investigations should be performed to identify any life-threatening hyperkalaemia in individuals with an AKI?

A

U&E and ECG

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18
Q

Which five bedside tests should be done in all individuals with an AKI?

A

Urinalysis, urine microscopy, bloods, ABG and ECG

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19
Q

If signs of infection are present in an individual with an AKI, what additional blood test should be done?

A

Blood cultures

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20
Q

If a systemic cause of AKI is suspected, what additional investigations should be performed?

A

Blood film and immunology tests

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21
Q

What is the first line imaging test for an AKI if necessary?

A

Renal ultrasound

22
Q

What is the second line imaging test for an AKI if necessary?

A

CT-KUB

23
Q

If there is an AKI with complete anuria, the cause is most likely to be what?

A

Obstructive

24
Q

What is the first line management for a patient with an AKI and anuria?

A

Catheterisation

25
Q

What are the two urgent indications for a renal biopsy in individuals with an AKI?

A

Suspected rapidly progressive GN or positive immunology

26
Q

You should not perform a renal biopsy if what type of AKI is suspected?

A

Post-renal

27
Q

Which patients with an AKI should undergo a myeloma screen?

A

Those aged > 50 with hypercalcaemia and anaemia

28
Q

What does a myeloma screen involve?

A

Protein electrophoresis and urine testing for Bence-Jones proteins

29
Q

How should fluids be given in patients with an AKI?

A

250ml bolus’ of crystalloid, reassessing fluid status after each one

30
Q

Senior help should be sought if a patient with an AKI has shown no improvement after receiving how much fluid?

A

1 litre

31
Q

Fluids containing what should be avoided in patients with an AKI?

A

Potassium

32
Q

Which drugs should always be withheld in patients with an AKI?

A

Gentamicin, ACE inhibitors/ARBs, NSAIDs

33
Q

When should metformin be withheld in patients with an AKI?

A

If creatinine is > 150micromol/l

34
Q

How should fluid status be monitored in patients with an AKI?

A

Fluid status should be assessed hourly, a fluid balance chart should be completed daily and daily weights should be taken

35
Q

How often should U&Es be tested in a patient with an AKI?

A

Daily

36
Q

How should AKIs be treated in order to be resolved?

A

Treat the underlying cause

37
Q

What happens to T waves and P waves in an ECG of someone with hyperkalaemia?

A

T waves are tall and tented, P waves are small or absent

38
Q

What happens to the PR interval in an ECG of someone with hyperkalaemia?

A

Increased

39
Q

What happens to the QRS complex in an ECG of someone with hyperkalaemia?

A

Broadened

40
Q

What is the immediate treatment to protect the myocardium in individuals with hyperkalaemia?

A

10mls 10% calcium gluconate IV over 2 minutes (repeat until ECG improves)

41
Q

What is the immediate treatment to move potassium back into cells in individuals with hyperkalaemia?

A

IV insulin (10 units Actrapid) and 50mls 50% dextrose over 30 minutes

42
Q

As well as insulin and dextrose, what other treatment can be used to shift potassium back into cells in individuals with hyperkalaemia?

A

Nebulised salbutamol

43
Q

What are the 4 major complications of an AKI, that are usually indications for the need for RRT?

A

Hyperkalaemia, pulmonary oedema, uraemia, acidaemia

44
Q

What drug is used to treat acute pulmonary oedema?

A

Furosemide

45
Q

What drug can be used to manage acidaemia?

A

Sodium bicarbonate

46
Q

Which type of renal replacement therapy is used in haemodynamically stable patients with an AKI?

A

Haemodialysis

47
Q

Which type of renal replacement therapy is used in haemodynamically unstable patients with an AKI?

A

Haemofiltration

48
Q

A potassium level of greater than what indicates the need for RRT in patients with an AKI?

A

7mmol/l

49
Q

A pH of less than what indicates the need for RRT in patients with an AKI?

A

7.2

50
Q

Overdoses with which drugs may require the need for RRT?

A

Barbiturates, lithium, alcohol (and ethylene glycol), salicylates and theophylline

Gen Med (Renal) (18 decks)

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