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Medicine & Surgery: Renal & Urology > AKI > Flashcards

AKI Flashcards

1
Q

What is an Acute Kidney Injury?

A

Syndrome of decreased renal function, measured by serum creatinine or urine output, occurring over hours to days.

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2
Q

What are the three different findings that diagnose an acute kidney injury?

A
  1. Rise in creatinine >26umol/L within 48h
  2. Rise in creatinine >1.5x baseline within 7 days
  3. Urine output <0.5ml/kg/h for >6 consecutive hours
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3
Q

What determines the severity of an acute kidney injury?

A

Highest creatinine rise or longest period/severity of oliguria.

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4
Q

What serum creatinine changes are present at each stage of an acute kidney injury?

A
  1. Rise >26.5umol/L or 1.5-1.9x baseline
  2. 2-2.9x baseline
  3. > 353.6umnol or >3x baseline or RRT
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5
Q

What urine output is present at each stage of acute kidney injury?

A
  1. <0.5ml/kg/h for 6-12h
  2. <0.5ml/kg/h for >12h
  3. <0.3ml/kg/h for >24h or anuria for >12h
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6
Q

What are the commonest causes of acute kidney injury?

A

Acute tubular injury:

  1. Sepsis
  2. Major surgery
  3. Cardiogenic shock
  4. Hypovolaemia
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7
Q

What are the prerenal causes of acute kidney injury?

A
  1. Hypovolaemia - haemorrhage, D&V, burns, pancreatitis
  2. Reduced CO - cardiogenic shock, MI
  3. Systemic vasodilation - sepsis, drugs
  4. Renal vasoconstriction - NSAIDs, ACEi, ARBs, hepatorenal syndrome
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8
Q

What are the renal causes of acute kidney injury?

A
  1. Glomerular - glomerulonephritis
  2. Interstitial - drug reaction, infection, sarcoid infiltration
  3. Vessels - vasculitis, DIC
  4. Tubular - Acute Tubular Necrosis
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9
Q

What are the postrenal causes of acute kidney injury?

A

Obstruction:

  1. Within renal tract - stone, malignancy, stricture, clot
  2. Extrinsic compression - pelvic malignancy, BPH, retroperitoneal fibrosis
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10
Q

What are the risk factors for developing an AKI?

A

Pre-existing CKD, old age, male, CVD, malignancy, diabetes mellitus, chronic liver disease, tubulointerstitial nephritis.

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11
Q

What signs and symptoms may be present in AKI?

A
  1. Signs - hypotension/hypertension, tachycardia

2. Symptoms - N&V, dizziness, orthopnoea, anuria, oliguria uraemic symptoms

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12
Q

What are the metabolic disturbances in AKI?

A
  1. Hyperkalaemia
  2. Hyperphosphataemia
  3. Metabolic acidosis
  4. Elevated urea and nitrogen
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13
Q

What are the daily requirements of water, sodium, and potassium for an adult?

A

Water - 30ml/kg/d
Sodium - 1mmol/kg/d
Potassium - 1mmol/kg/d

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14
Q

What are the functions of the kidneys?

A
  1. Acid-base balance
  2. Water balance
  3. Electrolyte balance
  4. Toxin removal
  5. Blood pressure control
  6. EPO, vitamin D
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15
Q

How should you investigate a suspected AKI?

A
  1. FBC, U&Es, LFTs, VBG, lactate
  2. Urinalysis and culture
  3. USS KUB, CXR, ECG
  4. Catheterisation
  5. MRI/CT to further evaluate causes of obstruction from USS
  6. Management requires diagnosis and treatment of underlying aetiology
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16
Q

How do you treat a prerenal AKI?

A

Correct volume depletion/increase renal perfusion via cardiac support, treat sepsis.

17
Q

How do you treat a renal AKI?

A

Refer for likely biopsy and specialist treatment.

18
Q

How do you treat a post-renal AKI?

A

Catheter, nephrostomy, urological intervention.

19
Q

Which drugs are neprhotoxic?

A 
DIAMOND HL:
D - diuretics
I - IV contrast
A - antibiotics
M - metformin
O - opiates
N - NSAIDs
D - digoxin
H - heparin
L - lithium
20
Q

What are the indications for renal replacement therapy in AKI?

A
  1. Fluid overload/pulmonary oedema unresponsive to medical therapy.
  2. Uraemia (e.g. pericarditis, encephalopathy)
  3. Severe/prolonged acidosis (pH<7.2), may be managed with bicarbonate.
  4. Recurrent/persistent hyperkalaemia.
21
Q

What are the signs and symptoms of hypovolaemia?

A

Hypotension, oliguria, non-visible JVP, poor tissue turgor, tachycardia, daily weight loss.

22
Q

What are the signs and symptoms of hypervolaemia?

A

Early - hypertension, raised JVP, lung crepitations, peripheral oedema
Late - hypotension, skin turgor, increased CRT

23
Q

How is hypovolaemia in an AKI treated?

A
  1. 500ml crystalloid over 15 mins (saline/Hartmann’s)
  2. Reassess fluid state
  3. Further boluses of 250-500ml with review after each
  4. Stop when euvolaemic or seek expert help when 2L given.
24
Q

How is hypervolaemia in AKI treated?

A
  1. Fluid resuscitation, give drugs in minimal fluid.
  2. Diuretics only in symptomatic overload.
  3. RRT

Medicine & Surgery: Renal & Urology (28 decks)

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