Acute Kidney Injury Flashcards

1
Q

What is acute kidney injury?

A

Acute drop in kidney function in <48hrs

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2
Q

What are the 3 diagnostic criteria?

A

Rise in serum creatine of >/= 26.4 micromol/l in 48hrs
OR
50+% rise in serum creatine within 7 days
OR
A fall in urine output <0.5ml/kg/hr for 6+ hrs

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3
Q

How are the causes of AKI split up?

Give 3 examples of each

What is the most common category of causes?

A
  1. Pre-renal (due to inadequate blood supply)
    - Dehydration
    - Hypotension
    - Heart failure

Renal (due to intrinsic disease)

  • Glomerulonephritis
  • Interstitial nephritis
  • Acute tubular necrosis (ATN)

Post-renal (obstruction to outflow)

  • Kidney stones
  • Masses in abdo/pelvis
  • Ureter/urethral strictures
  • Enlarged prostate/prostate cancer
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4
Q

When would an USS be indicated?

A

To check for obstruction of urinary tract in suspected post-renal AKI

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5
Q

What is the mnemonic to remember the nephrotoxic drugs that should be stopped in AKI?

A

DAMN

Diuretics
ACE/ARB
Metoformin
NSAIDS

(NB: ACEi are only causative in acute kidney injury - very useful for reducing proteinuria so used in other kidney conditions)

SPIRONOLACTONE AND GENTAMICIN

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6
Q

What is the useful mnemonic for assessment and management?

A

RENAL DRS 26

Record baseline creatine (+regular U+E's)
Exclude obstruction (clinical/USS)
Nephrotoxic drugs stopped
Assess fluid status
Losses +/- catherisation

Dipstick (blood/protein)
Review meds
Screen (consider acute renal screen)

26 creatine rise for AKI diagnosis

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7
Q

Why should an ECG be taken in a patient with AKI?

A

To check for hyperkalaemia

Peaked T wave

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8
Q

What can result from a build up of urea due to poor GFR?

A

Uraemic complications e.g. encephalopathy + pericarditis

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9
Q

What ABG is most likely in AKI?

A

Metabolic acidosis

due to lack of ammonia secretion - ammonia is an acid

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10
Q

What is the most common cause of AKI?

A

Acute tubular necrosis

Destruction and damage of the tubular epithelial cells

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11
Q

Muddy brown casts on urinalysis?

A

Acute tubular necrosis

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12
Q

What type of AKI accounts for 1/4 of drug induced AKI?

A

Acute interstitial nephritis

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13
Q

Rise in urea and creatine levels post new drug. Patient presents with fever and rash as well.

What is their urinalysis likely to show?
What condition is this?

A

Acute interstitial nephritis

Allergic picture

  • increased WCC
  • increased IgE
  • increased eosinophils
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14
Q

What kind of AKI can be caused by sepsis?

A

Acute tubular necrosis

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