Acute kidney injury

Question 1

Clinical features of AKI? (3)

Answer 1

• Anuria/oliguria (<0.5ml/kg/hr)
• Hypertension with fluid overload
• Rapid rise in plasma creatinine

Question 2

Serum creatine is raised more than…..???…. it is an AKI

urine output?

Answer 2

1.5x

<0.5 ml/kg for > 8hours

Question 3

what is an AKI 1, and 3 score? (creatinine levels)

Answer 3

1) 1.5-2
2) 2-3
3) 3

Question 4

what may drop and climb in AKI?

Answer 4

DROP - calcium

RISE - phosphate

Question 5

AKI - endocrine dysfunction

Answer 5

red cells / blood pressure / bone health

Question 6

what are the 3 M’S of AKI?

Answer 6

Monitor -
Paediatric Early Warning Scores(BP), Urine Output, weight

Maintain -
good hydration / electrolytes / acid - base

Minimise -
Drugs

Question 7

pre- renal causes of AKI are due to?

• some causes

Answer 7

perfusion problems

intravascular depletion - decreased GFR

gastroenteritis, sepsis , nephrotic syndrome, liver disease

Question 8

AKI- intrinsic renal causes?

Answer 8

HUS

Glomerulonephritis

Question 9

AKI - tubular injury causes?

interstitial nephritis?

Answer 9

acute tubular necrosis
(ATN)
Consequence of hypoperfusion
Drugs

• NSAIDS and anti biotics

Question 10

post renal causes of AKI?

Answer 10

obstructive uropathies

Question 11

What is the definition of Haemolytic Uraemic Syndrome

Answer 11

Packed cell volume less than 30% - fragmented red cells

Thrombocytopenia

Question 12

Haemolytic Uraemic Syndrome - clinical features

Answer 12

Packed cell volume less than 30%

Platelet count <150x10⁹/l

Serum creatinine greater than the age-related range (>97th pc)

GFR < 80, proteinuria

Question 13

Haemolytic-Uraemic Syndrome - often caused after?

organism?

other causes ?

Answer 13

bloody diarrhoea

Entero-Haemorrhagic E.coli (EHEC)
Verotoxin producing E.coli – VTEC
or Shiga toxin (STEC)

pneumococcal infection, drugs

Question 14

HUS presenting symptoms?

Answer 14

E coli O157:H7 serotype

Question 15

Vulnerable organs for Shiga Toxin dissemination

Answer 15

Kidneys, brain, lungs, pancreas, adrenals and heart

Question 16

The triad of HUS?

Answer 16

• Microangiopathic haemolytic anaemia
• Thrombocytopenia
• Acute Kidney Injury / Acute Renal Failure

Question 17

Management of Bloody diarrhoea and HUS?

Answer 17

Fluid balance - hypertension
Electrolytes
Acidosis
Waste
Hormones - hypertension

IV normal saline

Question 18

How can we prevent oliguric HUS ?

Answer 18

intravascular volume expansion

Question 19

long term consequences of AKI?

Answer 19

Blood pressure
Proteinuria monitoring
Evolution to CKD