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RENAL > Acute Kidney Injury (AKI) > Flashcards

Acute Kidney Injury (AKI) Flashcards

1
Q

What percentage of hospital inpatients get an AKI during their stay?

A

20%

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2
Q

More patients die in the short term (90 days) following an AKI than in the long term. TRUE/FALSE?

A

TRUE

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3
Q

How is AKI defined?

A

An abrupt (<48hrs) reduction in kidney function

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4
Q

How is AKI classified?

A 
A1 = Increase of serum creatinine by 1.5-1.9x baseline
A2 = Increase of serum Creatinine by 2.-2.9x baseline
A3 = Increase of serum Creatinine by >3x baseline OR the need for RRT
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5
Q

What are the risk factors for the development of an AKI?

A 
Older Age
CKD
Diabetes
Cardiac Failure
Liver Disease
Perpiheral Vascular Disease
Previous AKI
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6
Q

What is the main cause of pre-renal AKI?

A

Too little volume entering the glomerulus of the kidney
=> Hypotension
=> Hypovolaemia
=> Hypoperfusion of kidney

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7
Q

What can cause hypovolaemia and cause a pre-renal AKI?

A 
Haemorrhage
Volume depletion (e.g. Diarrhoea/Vomiting, burns)
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8
Q

What causes of hypotension can also cause an AKI?

A

Cardiogenic shock (e.g Heart Failure)

Distributive shock (e.g. sepsis, anaphylaxis)

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9
Q

What drugs are known to cause renal hypoperfusion?

A
  • NSAIDs
  • ACEi / ARBs
  • Hepatorenal syndrome
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10
Q

What normally happens to conteract low renal perfusion?

A

Angiotensin 2 constricts efferent arteriole

=> maintains GFR

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11
Q

Why do ACEi cause a major fall in GFR when there is decreased renal perfusion?

A

They block angiotensin 2 from constricting the efferent arteriole

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12
Q

Untreated pre-renal AKI results in what?

A

Acute tubular necrosis

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13
Q

What are the most important causes of Acute tubular necrosis?

A

Sepsis
Severe dehydration
Rhabdomyolosis
Drug toxicity

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14
Q

What can we assess to see if a patient is dehydrated?

A

BP/ HR
Urine Output
JVP/Oedema/Pulmonary oedema (may indicate fluid overload)
Cap Refill

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15
Q

What fluid should be given for hypovolaemia in AKI?

A

Crystalloid (0.9% NaCl)

Do NOT use 5% dextrose (as it doesnt stay in the intravascular space and increase BP)

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16
Q

What bolus of fluids should be given at first?

A

250mls

If >1000mls IN and no improvement, seek help

17
Q

What are the renal causes of AKI?

A
  • Vascular
  • Glomerulonephritis
  • Interstitial Nephritis
  • Tubular Injury
18
Q

What can cause interstitial nephritis?

A

Drugs (NSAIDs, PPI, Penicillin)
Infection (TB)
Systemic (sarcoid)

19
Q

What can cause tubular injury and eventually AKI?

A
  • Ischaemia
  • Drugs (gentamicin)
  • Contrast
  • Rhabdomyolysis
20
Q

A mention of sore throat in a history would point towards which cause of renal disease?

A

Group A strep. infection

21
Q

Rash and joint pains would point towards what cause of AKI?

A

Vasculitis

22
Q

What cause of AKI may be indicated by haemoptysis?

A

ANCA associated vasculitis (due to lung involvement)
OR
Goodpasture’s Syndrome (anti-GBM)

23
Q

If abnormal clotting was identified, what could be the cause of AKI?

24
Q

If one kidney was visibly bigger than the other, what is thought to be the cause?

A

Renal vascular issue

e.g. artery stenosis

25
Q

What type of patient would you be suspicious has a myeloma causing their AKI?

A

Older Pt
High Ca
Anaemic

26
Q

How would you investigate an AKI patient for a myeloma?

A

Protein electrophoresis

BJP

27
Q

If you think a patient has an AKI caused by sepsis, what must you remember to not give them?

A

Gentamicin

28
Q

What life threatening complications of AKI would warrant urgent dialysis?

A
  • Severe Hyperkalaemia
  • Fluid Overload (Pulmonary oedema)
  • Severe Acidosis (pH < 7.15)
  • Uraemic pericardial effusion
  • Severe Uraemia (Ur >40)
29
Q

What can cause the post-renal obstruction which can progress to AKI?

A

Stones
Cancers
Strictures
Extrinsic Pressure

30
Q

How can a post renal obstruction be visualised on imaging?

A

Dilated renal pelvis

31
Q

How is a post-renal obstruction relieved?

A

Catheter

Nephrostomy

32
Q

How are hyperkalaemias assessed?

A

ECG

Muscle weakness

33
Q

What level of K is considered life threatening hyperkalaemia?

34
Q

Describe the progression of ECG changes in hyperkalaemia

A

Peaked T wave
Flat P wave
Increased PR interval
Sine Wave Pattern

35
Q

If an ECG shows hyperkalaemia, what is the first treatment you should give?

A

10mls 10% calcium gluconate

  • doesnt reduce K
  • BUT protects myocardium
36
Q

What medications are used to get rid of the K?

A

Insulin (actrapid 10units)

50mls 50% dextrose

37
Q

What are sick day rules?

A

Medications to stop if you are ill

e.g. anti-hypertensives, NSAIDs, Diuretics

RENAL (24 decks)

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