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Charis & Ellie vs Renal > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

Definition of acute kidney injury?

A

Sudden acute drop in kidney function

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2
Q

How is acute kidney injury diagnosed?

A

Measuring serum creatinine

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3
Q

What is AKI characterized by?

A

-Rapid increase in blood urea & creatinine concentration caused by decreased glomerular filtration rate

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4
Q

Criteria for AKI?

A
  • Rise in creatinine of >26.4micromol/L in 48 hours
  • Rise in creatinine of >50%
  • Urine output of <0.5ml/kg/hour for more than 6 hours
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5
Q

Who can commonly get AKI?

A

Common for patients already in hospital

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6
Q

Risk factors for AKI?

A
  • CKD
  • Heart fialure
  • Diabetes
  • Liver diseasse
  • Older age (>65)
  • Cognitive impairment
  • Nephrotoxic medications: lithium, haldol
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7
Q

Classifying causes of acute renal injury?

A

Pre-renal
Renal/Intrarenal
Post-renal

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8
Q

Which is the most common type of cause of AKI?

A

Pre-renal

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9
Q

What is pre-renal caused AKI due to?

A

Inadequate supply to kidneys reducing filtration of blood

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10
Q

What can cause the inadequate blood supply resulting in pre-renal AKI?

A
  • Dehydration
  • Hypotension (shock/volume depletion)
  • Heart failure (reduced effective circulating volume)
  • Renal artery stenosis
  • Renal hyperfusion
  • Pharmacological (NSAIDs, ACEi)
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11
Q

What is renal AKI?

A

Where intrinsic disease in kidney is leading to reduced filtration of blood

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12
Q

Possible causes of Renal AKI?

A
  • Ischaemic injury
  • Nephrotoxic injury
  • Immune-mediated injury
  • Vasculitis/vascular disease
  • Interstitial nephritis
  • Glomerulonephritis
  • Acute tubular necrosis
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13
Q

What is the cause of post-renal AKI?

A

Obstruction to outflow of urine from kidney, causing back-pressure into kidney and reduced kidney function

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14
Q

What is the cause of post-renal AKI called?

A

Obstructive uropathy

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15
Q

What can renal obstruction be caused by?

A
  • Kidney stones
  • Blood clots
  • AAA
  • Masses eg cancer (usually retroperitoneal)
  • Ureter or ureteral strictures
  • Enlarged prostate/prostate cancer
  • Bladder issues (malignancy, blood clot)
  • strictures
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16
Q

Signs/symptoms of AKI?

A

Non-specific:

  • Anorexia, wt loss, fatigue, lethargy
  • N/V
  • Itch
  • Fluid overload

Signs:

  • Uraemia including itch
  • Pericarditis
  • Oliguria
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17
Q

What may pre-renal AKI presnet with?

A
  • Hypovolaemia

- Hypotension

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18
Q

What does hypotension/hypovolaemia present as?

A
  • Thirst
  • Dizziness
  • Weakness
  • Diarrhoea
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19
Q

Investigations for AKI?

A
  • Urinalysis: protein, blood, glucose, nitrates
  • U&Es
  • FBC and coags
  • Immunology: ANA, ANCAM, GBM
  • Protein electrophoresis
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20
Q

How many stages in KDIGO staging and what is it?

A

3 stages

Kidney disease Improving Global Outcomes criteria

21
Q

Stage 1 KDIGO?

A 
Serum Creatinine:
-Increase >26 micromol/L within 48 hours 
OR 
-1.5 fold increase in serum creatinine 
OR 
-
-GFR decrease

or

Urine output criteria:
- <0.5ml’Kg/h for 6 hours

22
Q

Stage 2 KDIGO?

A

Serum creatinine criteria:

  • 2 fold increase in serum creatinine
  • GFR decrease >50%

OR

Urine output criteria:
-<0.5ml/Kg/h for >12 hours

23
Q

Stage 3 KDIGO?

A 
Serum creatinine criteria:
- 3 fold increase in serum creatinine 
OR
-Increase >354 micromol/L 
OR 
-GFR decrease >75% 
OR 
started on renal replacement therapy

OR

Urine output criteria:
- <0.3mL/Kg/hr for >24 hours of 12 hours for anuria

24
Q

Prevention of CKD?

A
  • Avoiding nephrotoxic meds where possible

- Ensuring adequate fluid input in unwell patients

25
First step to treat AKI?
Treat underlying cause
26
How to treat underlying cause in pre-renal AKI?
Fluid rehydration fluid challenge for hypovolaemia - crystalloid (0.9% NaCl)// colloid - don't use dextrose/Harmans (K) - bolus of fluid - reassess - repeat - if 1000 ml & no improvement - seek help
27
How to treat underlying cause for drug induced AKI?
Stop nephrotoxic meds (NSAIDs and antihypertensives) that reduce filtration pressure (ACEis)
28
How to treat underlying cause in Post-renal AKI?
Relieve obstruction eg insert catheter for enlarged prostate, nephroplasty refer to urology if ureteric stenting required
29
How to manage fluids?
Hypovolaemia: fluid boluses (250-500ml crystalloid) Hypervolemia: Diuretics?
30
What does hyperkalaemia predispose to?
Cardiac arrhythmias
31
What are patients with AKI susceptible to ?
Hyperkalaemia
32
Treating hyperklamiea?
IV calcium gluconate
33
What is the renal replacement therapy of choice?
Haemodialysis
34
Indications for haemodialysis?
``` A: Acidaemia E: Electrolytes (Hyperk) I: Ingestion/toxins O: Overload (fluid) U: Uraemia and uraemic complications ```
35
Complications of AKI?
- Hyperkalaemia - Fluid overload, heart failure , pulmonary oedema - Metabolic acidosis - Uraemia can--> encephalopathy or pericarditis
36
What tests can diagnose cause of AKI?
- Urinalysis - FBC - Renal tract imaging - Renal biopsy
37
How can AKI be prevented?
Miantaining adequate BP Volume status Avoiding nephrotoxic meds
38
Nephrotoxic drugs are?
- NSAIDs - ACEis - ARBs
39
a definition of pre-renal AKI?
reversible volume depletion leading to - oliguria <0.5 ml/kg/hr and increase in creatinine
40
what is the pathophysiology of pre-renal AKI?
``` hypovolaemia - haemorrhage - D&V - burns hypotension - cardiogenic shock - sepsis - anaphylaxis renal hypoperfusion (<20% CO) - NSAID/ COX2 - hepatorenal syndrome - ACEi/ARBs decreased renal perfusion activates RAAS to try and increase GFR if ACEi: can't activate RAAS - vasodilation of efferent arteriole ```
41
what is the prognosis of pre-renal AKI?
if untreated - acute tubular necrosis - commonest hospital AKI - sepsis, severe dehydration - rabdomyolysis and drug toxicity
42
what are the possible pathogenesis of renal AKI?
vascular - vasculitis: GPA, MPA, renovascular disease glomerulus - glomerulonephritis interstitial nephritis - drugs: NSAIDs, penicillin, infection: TB, systemic: sarcoid tubular injury - ischaemia - renal hypoperfusion, drugs: gentamicin, contrast and rhabdomyolysis
43
what is the presentation of renal AKI?
constitutional: anorexia, fatigue, lethargy N&V uraemia - itch fluid overload - oedema, SOB, HTN, effusion oliguria
44
how is renal AKI managed?
``` investigations U&E – marker of renal function: Na, Ur, Cr FBC &Coagulation o abnormal clotting – sepsis o anaemia – EPO urinalysis – haematoproteinuria USS – obstruction immunology – ANA (SLE), ANCA, GBM Protein electrophoresis & BJP – myeloma ``` Treatment establish good perfusion pressure: fluid resuscitation - inotropes, vasopressors treat underlying cause: antibiotics if sepsis stop nephrotoxics dialysis if anuric & uraemia
45
hyperkalaemia
normal K 3.5- 5.0 hyperkalaemia >5.0 life-threatening >6.5
46
how is hyperkalaemia investigated?
muscle weakness ECG - peaked T waves (6-7mmol) - flattened p wave, prolonged PR, depressed ST, peaked T wave (7-8 mmol) - atrial stand still, prolonged QRS, peaked T wave (8-9 mmol) - sine-wave (>9 mmol)
47
how is hyperkalaemia managed?
cardiac monitor & IV access protect myocardium: 10ml 10% calcium gluconate (2-3 min) move K+ back into cells - insulin-actrapid 10 units with - 50ml 50% dextrose (30 min) - salbutamol nebs (90 min) prevent GI absorption - calcium resonium (NOT in acute setting)
48
indications for haemodialysis
hyperkalaemia (>7/>6.5 unresponsive to medical therapy severe acidosis pH <7.15 fluid overload urea > 40 (pericardial rub/effusion)
49
drugs to avoid in AKI
``` NSAID ACEi/ARB diuretics gentamicin contrast trimethoprim – hyperkalaemia K+ sparing diuretics ```

Charis & Ellie vs Renal (40 decks)

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