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renal > Acute Kidney Injury L14 > Flashcards

Acute Kidney Injury L14 Flashcards

1
Q

What is acute kidney injury?

A

A rapid (hours to days) decline in kidney function.

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2
Q

Why is creatinine used to measure AKI rather than eGFR?

A

eGFR is not an accurate measurement if kidney function is changing over a short period of time

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3
Q

describe the stages of AKI in terms of creatinine levels and urine output.

A

Stage 1:

  • > 26microM increase (50-100% from baseline) creatinine
  • <0.5ml/kg/hour urine output for 6 hours

Stage 2:

  • 100-200% increase in creatinine
  • <0.5ml/kg/hour for 12 hours

Stage 3:

  • > 200% increase or >345microM
  • <0.3ml/kg/hour for 24 hours or anuria for 12 hours

*stage 3 is the most severe and patients tend to decline from stage 1 to stage 3

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4
Q

Who is at risk of Acute Kidney Injury?

A
  • old age
  • diabetes mellitus
  • hypertension
  • heart disease
  • liver disease
  • CKD
  • medication: diuretics, ACEi/ARB, NSAIDs, Gentamicin, vancomycin, chemotherapy
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5
Q

what are the three types of causes of AKI?

A
  • pre-renal
  • renal
  • post-renal
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6
Q

What is the main pre-renal cause of AKI?

A

perfusion failure

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7
Q

What conditions can lead to perfusion failure in the kidney?

A
  • hypotension
  • hypovolaemia
  • renal artery occlusion
  • can be made worse by
  • RAS blockade
  • NSAIDs
  • antihypertensives
  • diuretics
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8
Q

What is the autoregulatory range?

A

The range of systolic blood pressures through which blood flow to the kidney remains relatively constant (due to changes in efferent and afferent arterioles)

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9
Q

If blood pressure and blood volume are high, what happens to the renal perfusion rate and urine production?

A
  • renal perfusion rate increases
  • urine production remains normal

*still within autoregulatory range

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10
Q

If blood pressure and blood volume are normal, what happens to the renal perfusion rate and urine production?

A
  • renal perfusion and urine production are both normal

* within autoregulatory range

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11
Q

If blood pressure and blood volume are low (but within autoregulatory range), what happens to the renal perfusion rate and urine production?

A
  • renal perfusion and urine production are normal - autoregulated
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12
Q

If blood volume and blood pressure are very low, what will happen to the renal perfusion rate and urine production?

A
  • renal perfusion and urine production decrease - out of autoregulatory range > cannot be regulated > problems with kidney function and homeostasis
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13
Q

List the different molecules used to block RAAS.

A
  • renin inhibitors (binds to renin to stop conversion > At1)
  • ACE inhibitors
  • mineralocorticoid receptor antagonist (blocks aldosterone)
  • At2 receptor blockers
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14
Q

What is the purpose of RAAS blockade?

A
  • stop arteriolar constriction
  • stop rise in blood volume

> stop rise in BLOOD PRESSURE

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15
Q

In a normal kidney at high blood pressure, what happens to the afferent and efferent arterioles to maintain renal perfusion across glomerulus?

A

afferent - constricts

efferent - relative dilation

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16
Q

In a normal kidney at low blood pressure, what happens to the afferent and efferent arterioles to maintain renal perfusion across glomerulus?

A

afferent - dilates

efferent - constricts

17
Q

How does RAAS blockade decrease renal perfusion?

A

inhibits efferent arteriolar constriction so at low blood pressure, lose perfusion across glomerulus

18
Q

How do NSAIDs stop decrease perfusion?

A

inhibit afferent arteriolar dilation (constrict vessels) so at low blood pressure, perfusion across glomerulus not maintained as it would normally

19
Q

What is the treatment of perfusion failure?

A
  • treat underlying cause
  • fluid replacement
  • BP support (inotropic drugs e.g.NA/A)
  • restore arterial patency (taking clots out, stents etc.)
  • stop RAS blockade
  • stop NSAIDs
20
Q

What is the main post-renal cause of AKI?

A

obstruction in kidney/urinary tract

21
Q

What is the treatment of obstruction?

A
  • bypass or remove obstruction
  • nephrostomy (urine from renal pelvis > bag outside body)
  • bladder catheter
  • lithotripsy (destruction of stones)
  • take out tumours
  • dilate strictures
22
Q

What are the renal causes of AKI?

A

diseases that damage

  • tubules
  • glomerulus
  • interstitium
23
Q

systemic renal causes of AKI?

A

vasculitis, SLE (lupus), myeloma

24
Q

infectious renal causes of AKI?

A

HIV, endocarditis

25
Q

allergic renal causes of AKI?

A

acute interstitial nephritis

26
Q

other renal causes of AKI?

A

drug toxicity - gentamycin, NSAID, chemotherapy

Glomerulonephritis

27
Q

What is systemic vasculitis?

A

a type of vasculitis that destroys blood vessels through inflammation. A subgroup of this is ANCA associated vasculitis - it is a rare disease and airway and renal organs are most commonly affected.

ANCA = anti-neutrophil cytoplasmic antibody

28
Q

What are the treatments for inflammatory renal disease? What are the complications with each?

A
  • steroids - diabetes, infection, osteoporosis, skin damage, weight gain
  • cyclophosphamide - infections, malignancy, bone marrow supression, infertility
  • plasma exchange - infection, bleeding, risks of central lines
  • azathioprine/mycophenolate - infection, cancer, liver abnormalities
29
Q

What are the main causes of death in AKI?

A
  • underlying disease
  • infection
  • hyperkalaemia
  • acidosis
  • pulmonary oedema

renal (16 decks)

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