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Acute Care & Trauma > Acute Kidney Injury (AKI) > Flashcards

Acute Kidney Injury (AKI) Flashcards

1
Q

Define Acute Kidney Injury (AKI)?

A

An abrupt loss of kidney function resulting in the retention of urea and other nitrogenous waste products and dysregulation of extracellular volume and electrolytes

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2
Q

What is the KDIGO classification of AKI?

A

Increase in serum creatinine > 26 µmol/L within 48 hrs

Increase in serum creatinine to > 1.5 times baseline within the preceding 7 days

Urine volume < 0.5 ml/kg/hr for 6 hours

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3
Q

What is the Aetiology of AKI?

A

Pre-Renal (90%)

Intrinsic Renal

Post-Renal (due to obstruction)

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4
Q

What are the Pre-Renal causes of AKI?

A

Hypovolaemia (e.g haemorrhage, severe vomiting)

Heart Failure

Cirrhosis

Nephrotic Syndrome

Hypotension (e.g shock, sepsis, anaphylasis)

Renal Hypoperfusion (e.g NSAIDs, ACE inhibitors, ARBs, renal artery stenosis)

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5
Q

What are the intrinsic renal risk factors of the AKI?

A

Glomerular - Glomerulonephritis, haemolytic uraemic syndrome

Tubular- acute tubular necrosis

Interstitial- acute interstitial nephritis (e.g. NSAIDs, Autoimmune)

Vasculitides (e.h. Wegener’s granulomatosis)

Eclampsia

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6
Q

What are the Post-Renal causes by AKI?

A

Calculi

Urethral Stricture

Prostatic Hypertrophy or malignancy

Bladder Tumour

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7
Q

What are the risk factors of AKI?

A

Age

Chronic Kidney Disease

Comorbidities (e.g. heart failure)

Sepsis

Hypovolaemia

Use of Nephrotoxic Medications

Emergency Surgery

Diabetes Mellitus

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8
Q

What is the epidemiology of AKI?

A

15% of adults admitted to hospital will develop an AKI

Most common in the elderly

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9
Q

What are the presenting symptoms of AKI?

A

Depends on Underlying CAUSE

Oliguria/anuria (abrupt anuria suggests post-renal obstruction)

Nausea/Vomiting

Dehydration

Confusion

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10
Q

What are the signs of AKI on physical examination?

A

Hypertension

Distended Bladder

Dehydration - postural hypotension

Fluid overload (in heart failure, cirrhosis, nephrotic syndrome) - raised JVP, pulmonary and peripheral oedema

Pallor, rash, brusing (vascular disease)

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11
Q

What are the appropriate investigations for AKI?

A

Urinalysis

Bloods

Ultrasound

Other Imaging:

CXR - pulmonary oedema

AXR - renal stones

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12
Q

What is the Urinalysis you can do for AKI?

A

Blood - suggests nephritic cause

Leucocyte Esterase and nitrites - UTI

Glucose

Protein

Urine Osmolality

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13
Q

What are the Bloods you can do for AKI?

A

FBC

Blood FIlm
U&Es

Clotting

CRP

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14
Q

What are the Immunology Bloods you can do for AKI?

A
  • Serum Immunoglobulins and protein electrophoresis for multiple myeloma
    • Also check for Bence-Jonce proteins in the urine
  • ANA- associated with SLE
    • Also check anti-dsDNA antibodies (high in active lupus)
  • Complement Levels - low in active lupus
  • Anti-GBM antibodies - Goodpasture’s syndrome
  • Antistreptolysin-O antibodies -high after Streptococcal infection
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15
Q

What are the Virology tests you can do for AKI?

A

Check for Hepatitis

Check for HIV

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16
Q

Why would you do an US for AKI?

A

Check for post-renal cause

Look for hydronephrosis

17
Q

What is the general management for AKI?

A

Treat the cause

Monitor Serum Creatinine, Sodium, Potassium, Calcium, Phosphate and Glucose

Identify and treat infection

Urgent relief of urinary tract obstruction
Refer to nephrology if intrinsic renal disease is suspected

18
Q

What are the four main components to management?

A

Protect Patient from hyperkalaemia (calcium gluconate)

Optimise fluid balance
Stop Nephrotoxic Drugs

Consider for dialysis

19
Q

When is the Renal Replacement Therapy (RRT) considered?

A

Hyperkalaemia refractory to medical management

Pulmonary Oedema refractory to medical mnagement

Severe metabolic Acidaemia

Uraemic Complications

20
Q

What are the possible complications of AKI?

A

Pulmonary oedema

Acidaemia

Uraemia

Hyperkalaemia

Bleeding

21
Q

What is the prognosis for patients with AKI?

A

Inpatient Mortality varies depending on cause and comorbities

Patients who develop AKI are at increased risk of developing CKD

22
Q

What are the indicators of poor prognosis?

A

Age

Multiple Organ Failure

Oliguria
Hypotension

CKD

Acute Care & Trauma (25 decks)

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