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Year 3 Renal Core Conditions > Acute Renal Failure > Flashcards

Acute Renal Failure Flashcards

1
Q

What is the AKI?

A

A rapid deterioration in renal function occuring over hours and days.
Measured by serum urea and creatinine.

  • failure to maintian electrolytes and acid base balance
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2
Q

What is the amount of urine that should normally be produced per hour?

A

0.5ml / Kg / hour

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3
Q

how common is AKI?

A

AKi occurs in 18% of hospital patients

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4
Q

What is the criteria for diagnosing AKI

A

1) Rise in creatinine >26umol/L in 48h
2) greater than 1.5X baseline.
3) Urine output <0.5ml/Kg/hour for more than 6 consecutive hours

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5
Q

What is the criteria for STAGE 1 AKI?

A

1) Serum creatinine rise by 1.5X baseline OR more than 26umol/L in 48hrs.
2) Urine output is less than 0.5mL/Kg/hour for 6 consecutive hours

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6
Q

What should the normal creatinine level be?

A

70 - 150 umol/L

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7
Q

What is the criteria for STAGE 2 AKI?

A

1) Serum creatine rise 2-2.9 X baseline.

2) Urine output of less than 0.5ml/kg/h for 12h

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8
Q

What is the criteria for STAGE 3 AKI?

A

1) Serum creatinine rise more than 3X baseline or >354umol/L

2) urine output of less 0.3mL/Kg/h for 24 h (or anuria for 12h)

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9
Q

What are the causes of raised creatinine other than altered renal function?

A
  • high muscle mass
  • red meat ingestion
  • rhabdomyolysis (muscle damage)
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10
Q

What are the pre-renal causes of AKI?

A

Pre-renal = reduced perfusion leads to fall in GFR.

Hypovolaemia:

  • dehydration,
  • haemorrhage
  • vomiting

(cirrhosis / Sepsis —-> hypotension)

(cardiac failure / cardiogenic shock —> low cardiac output)

Drugs:

  • diuretics
  • NSAIDs
  • ACEi (renal stenosis —> AKI)
  • amphotericin B
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11
Q

What are the intra renal causes of AKI?

A

Renal = (damage to tubule, vessel or glomerulus)

  • acute tubular necrosis
  • nephrotic syndrome
  • scarring from pyelonephritis

Vascular

  • vasculitis
  • cholesterol embolus
  • glomerulonephritis

-gentamicin

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12
Q

What are the post renal causes of AKI?

A

Post renal = obstruction —> can’t pass urine —-> back pressure affects function.

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13
Q

What are the symptoms of AKI?

A

Uraemia:

  • loss of appetitie
  • nausea + vomiting
  • pruritis (itch)

Neuro:

  • drowsiness
  • fits
  • coma

Bleeding:

  • epistaxis (nose bleed)
  • GI bleed
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14
Q

What are the metabolic complications of AKI?

A
  • hyperK+
  • metabolic acidosis
  • HypoNa (in fluid overload)
  • Pulmonary oedema due to salt and water retention
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15
Q

What are the invx done for AKI?

A

1) identify if pre-renal, renal, or post renal cause. Identify if acute or acute of CKD.
2) Urine dipstick (nitrites? Leuc? haem?)
3) MSU (look for red cells - glomerulonephritis, protein?)
4) Kidney injury molecule 1,neutrophil gelatinase associated lipocalin. (rises within few hours of AKI.

5) Bloods
FBC
U+E (serum urea, electolytes, creatinine,)
calcium
LFTS (albumin, alk phos)
serum phosp
Coagulation screen
Blood cultures
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16
Q

How is AKI managed?

A
  • monitor fluid balance and electrolytes
  • daily weight
  • lying standing BP
  • withhold nephrotoxins
  • treat hyper K+ with IV sodium bicarbonate.
  • Treat pulmonary oedema with IV furosemide
  • Sepsis treat with IV Abx
  • renal replacement therapy ( haemodialysis and haemofiltration) if hyperK+ not controlled, Pulmonary oedema unresponsive to diuretics, removal of nephrotoxic drugs.
17
Q

When would renal replacement therapy (haemodialysis and haemofiltration) be used to treat AKI

A

1) symptomatic Uraemia (pericarditis)
2) HyperK+ (that is uncontrollable)
3) Pulmonary oedema (unresponsive to diuretic)
4) sever acidosis
5) removal of nephrotoxic drugs e.g. gentamicin, lithium, severe aspirin overdose.

18
Q

What are the complications of HyperK+?

A

life threatening as it can cause cardiac dysrhythmias, particularly ventricular fibrillation.

19
Q

What are the risk factors for AKI?

A

Vascular:

  • Cardiac failure
  • Peripheral vascular disease

Infective:

  • sepsis
  • history of urinary symptoms

Metabolic:
- Diabetes

Iatrogenic:

  • Nephrotoxic drugs (gentamicin, lithium, aspirin overdose)
  • Poor fluid intake

Degenerative:

  • CKD
  • Chronic liver disease

Other
- Age 75+

20
Q

How can you tell if its AKI or CKD?

A
  • if kidneys are small on USS then suspect CKD

Signs of chronic disease:

  • low Ca2+
  • high phosphate
  • anaemia

Previous blood results showing high creatinine / low GFR

Year 3 Renal Core Conditions (10 decks)

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