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Acute Kidney Injury Flashcards

1
Q

What can be used to determine if someone has AKI?

A

Serum creatinine or urine output

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2
Q

What are the criteria for AKI?

A

Rise in creatinine >26 micromoles per L within 48h, rise in creatinine >1.5x baseline within 7 days, urine output <0.5ml per kg per h for >6 consecutive days

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3
Q

What are the commonest causes of AKI?

A

Sepsis, major surgery, cardiogenic shock, other hypovolaemia, drugs, hepatorenal syndrome, obstruction

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4
Q

What are pre-renal causes due to?

A

Low blood volume or low effective circulating volume

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5
Q

What are renal causes due to?

A

Glomerular, tubular, interstitial, vascular

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6
Q

What are post-renal causes due to?

A

Obstruction to urine

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7
Q

What are risk factors for AKI?

A

HTN, volume depletion, CKD, diabetes, cirrhosis, nephrotoxic meds, cancer, trauma

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8
Q

What can lead to pre-renal AKI?

A

Decreased vascular volume, decreased cardiac output, systemic vasodilation, renal vasoconstriction

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9
Q

What can cause pre-renal AKI?

A

Haemorrhage, diarrhoea and vomiting, dehydration, shock, cirrhosis, CCF

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10
Q

What can cause glomerular disease?

A

Glomerulonephritis

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11
Q

What can cause interstitial disease?

A

Acute interstitial nephritis

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12
Q

What can cause vessel disease?

A

Vasculitis, microangiopathic haemolytic anaemia

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13
Q

What are some post-renal causes of AKI?

A

Problem within renal tract, extrinsic compression

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14
Q

What can cause post-renal AKI?

A

Stones, BPH, Cancer, pyelonephritis

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15
Q

What are general features of AKI?

A

Oliguria, high creatinine, hyperkalaemia, uraemia, hypocalcaemia/hyperphosphataemia

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16
Q

What USS result suggests CKD?

A

Small kidneys

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17
Q

What USS result suggests renal vascular disease?

A

Asymmetry

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18
Q

What are some differential diagnoses?

A

CKD, drug side effect

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19
Q

What drugs are nephrotoxic/should be stopped?

A

NSAIDs, ACEi, ARB, metformin, lithium, digoxin

20
Q

How do you manage pre-renal AKI?

A

Correct volume depletion and/or increase renal perfusion via circulatory/cardiac support, treat any underlying sepsis

21
Q

How do you manage renal AKI?

A

Refer for biopsy and specialist treatment of intrinsic renal disease

22
Q

What management is common to all AKI?

A

Fluid balance, Acidosis, hyperkalaemia, recognition of patients who may need renal replacement

23
Q

How do you manage hypovolaemia?

A

500ml crystalloid, reassess, further boluses of 250-500ml with review after each up to 2L

24
Q

How do you manage hypervolaemia?

A

Oxygen supplementation if needed, fluid restriction, diuretics if symptomatic

25
What is mild acidosis?
pH 7.30 - 7.36 with bicarb >20 mmol per L
26
How do you manage acidosis?
Treat underlying disorder. Can give sodium bicarbonate but be cautious
27
What are the issues with sodium bicarbonate?
It generates CO2 so you need to make sure patient has adequate ventilation to prevent respiratory acidosis. Can cause an increase in sodium and volume load
28
What ECG changes can occur in hyperkalaemia?
Tall tented T waves, increased PR interval, small/absent P waves, widened QRS complex, sine wave pattern, asystole
29
What cardioprotection can you give in hyperkalaemia?
Calcium chloride or calcium gluconate
30
What can you give to decrease potassium levels?
IV insulin (+ glucose), salbutamol
31
What renal replacement therapy is available?
Haemodialysis, haemofiltration
32
What are indications to start renal replacement therapy?
Fluid overload unresponsive to treatment, severe/prolonged acidosis, recurrent/persistent hyperkalaemia despite treatment, uraemia
33
What is stage 1 AKI?
Serum creatinine >26.5 or 1.5-1.9x baseline. Urine output <0.5 ml per kg per h for 6-12h
34
What is stage 2 AKI?
2.0-2.9x baseline. Urine output <0.5ml per kg h for >12h
35
What is stage 3 AKI?
>353.6 or 3.0x baseline or renal replacement therapy. Urine output <0.3 ml per kg per h for >24h or anuria for >12h
36
What can cause tubular disease?
Necrosis
37
What does hyperkalaemia cause?
Arrhythmias, muscle weakness
38
What does uraemia cause?
Nausea and vomiting, pericarditis, platelet dysfunction
39
What are some pre-renal specific presentations?
Hypotension, signs of liver/heart failure
40
What are some intra-renal specific presentations?
Infection, signs of underlying disease
41
What are some post-renal specific presentatons?
LUTS
42
What main investigations would you do?
U&E to determine eGFR, Creatinine
43
What other investigations would you do?
Iron, sodium, urea, fluid state, FBC, urinalysis, USS/KUB CT
44
What are potential complications?
End stage renal failure, metabolic acidosis, uraemia, CKD
45
What is the most common cause of AKI?
Acute tubular necrosis

Renal/GU (15 decks)

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