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Renal/GU > Acute Kidney Injury > Flashcards

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
Q

What is mild acidosis?

A

pH 7.30 - 7.36 with bicarb >20 mmol per L

26
Q

How do you manage acidosis?

A

Treat underlying disorder. Can give sodium bicarbonate but be cautious

27
Q

What are the issues with sodium bicarbonate?

A

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
Q

What ECG changes can occur in hyperkalaemia?

A

Tall tented T waves, increased PR interval, small/absent P waves, widened QRS complex, sine wave pattern, asystole

29
Q

What cardioprotection can you give in hyperkalaemia?

A

Calcium chloride or calcium gluconate

30
Q

What can you give to decrease potassium levels?

A

IV insulin (+ glucose), salbutamol

31
Q

What renal replacement therapy is available?

A

Haemodialysis, haemofiltration

32
Q

What are indications to start renal replacement therapy?

A

Fluid overload unresponsive to treatment, severe/prolonged acidosis, recurrent/persistent hyperkalaemia despite treatment, uraemia

33
Q

What is stage 1 AKI?

A

Serum creatinine >26.5 or 1.5-1.9x baseline. Urine output <0.5 ml per kg per h for 6-12h

34
Q

What is stage 2 AKI?

A

2.0-2.9x baseline. Urine output <0.5ml per kg h for >12h

35
Q

What is stage 3 AKI?

A

> 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
Q

What can cause tubular disease?

A

Necrosis

37
Q

What does hyperkalaemia cause?

A

Arrhythmias, muscle weakness

38
Q

What does uraemia cause?

A

Nausea and vomiting, pericarditis, platelet dysfunction

39
Q

What are some pre-renal specific presentations?

A

Hypotension, signs of liver/heart failure

40
Q

What are some intra-renal specific presentations?

A

Infection, signs of underlying disease

41
Q

What are some post-renal specific presentatons?

A

LUTS

42
Q

What main investigations would you do?

A

U&E to determine eGFR, Creatinine

43
Q

What other investigations would you do?

A

Iron, sodium, urea, fluid state, FBC, urinalysis, USS/KUB CT

44
Q

What are potential complications?

A

End stage renal failure, metabolic acidosis, uraemia, CKD

45
Q

What is the most common cause of AKI?

A

Acute tubular necrosis

Renal/GU (15 decks)

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