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Y4 Acute Care > AKI > Flashcards

AKI Flashcards

1
Q

What are the NICE criteria that define AKI? (3 things)

A
  1. Creatinine rise of 25+ micromol/L in 48 hrs
  2. Creatinine rise of 50+% in 7 days
  3. Urine output of 0.5– ml/kg/hr for 6+ hrs

Any 1 of dem = AKI

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2
Q

What are the Risk Factors for AKI? (7 things)

A
  1. Age (65+)
  2. CKD
  3. HF
  4. DM
  5. Liver disease
  6. Nephrotoxic medications (NSAIDS / ACEi / ARBs / Diuretics like Spironolactone / Aminoglycosides)
  7. Iodinated contrast medium in CT scans
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3
Q

What are the 3 types of causes of AKI?

A
  1. Pre-renal
  2. Instrinsic
  3. Post-renal
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4
Q

What is the most common Type of cause of AKI?

A

Pre-renal

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5
Q

What are the Pre-Renal causes of AKI? (4 things)

A
  1. Reduced CO (Cardiogenic Shock / MI)
  2. Reduced blood volume (Haemorrhage / DnV / Pancreatitis)
  3. Systemic Vasodilation (Sepsis)
  4. Renal Vasoconstriction (NSAIDs / ACEi / ARBs)
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6
Q

What are the Instrinsic causes of AKI? (3 things)

A
  1. Glomerular (GN / ATN)
  2. Interstitial (Drug reaction / Inf)
  3. Vasculitis
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7
Q

What are the Post-Renal causes of AKI? (2 things)

A
  1. Within Renal Tract (Stone / Stricture / Clot / Cancer)
  2. Extrinsic Compression (Pelvic Cancer / BPH)
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8
Q

What are the CF of Pre-Renal AKI? (6 things)

A

Dehydration + Hypovolaemia:

  1. Postural hypotension
  2. Dizziness
  3. Thirst
  4. Prolonged cap refill
  5. Reduced skin turgor
  6. Reduced urine output
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9
Q

What are the CF of Intrinsic AKI? (6 things)

A
  1. Glomerular: Nephrotic / Nephritic Syndrome
  2. Interstitial (e.g Acute Interstitial Nephritis) : Fever / Arthralgia / Rashes / Eosinophilia
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10
Q

What are the CF of Post-Renal AKI? (8 things)

A
  1. Urinary Stones: Loin-groin pain / Haematuria / N+V
  2. BPH: Dysuria / Frequency / Dribbling
  3. Bladder Neck Obst: Palpable Bladder / Tender Suprapubic Area
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11
Q

What investigations should you do for sus AKI? (4 things)

A
  1. Urinalysis
  2. US / CXR / Renal Doppler / MRA
  3. ECG
  4. Bloods
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12
Q

What will results of Urinalysis suggest in sus AKI?

A
  1. Leucocytes / Nitrites = Inf
  2. Protein + Blood = Acute Nephritis / Positive Infection
  3. Glucose = Diabetes
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13
Q

What are you looking for in CT of sus AKI?

A

Obst uropathy (e.g. hydronephrosis)

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14
Q

What are you looking for in CXR of sus AKI?

A

Signs of fluid overload

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15
Q

What are you assessing in Renal Doppler of sus AKI?

A

Renal vascular assessment

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16
Q

What are you asessing in MRA (MR Angiography) of sus AKI?

A

Renal vascular assessment

17
Q

What are the management options for AKI? (4 things)

A
  1. Pre-Renal: IV Fluid rehydration
  2. Post-Renal: Relieve obst (e.g catheter for pt w retention bc enlarged prostate)
  3. Stop Nephrotoxic Meds (e.g ACEi / NSAIDs / Spironolactone)
  4. Manage complications
  5. Renal Replacement Therapy
18
Q

What are the complications of AKI? (4 things)

A
  1. Hyperkalaemia
  2. Metabolic acidosis
  3. Fluid overload / HF / Pulmonary Oedema
  4. Uraemia –> Encephalopathy / Pericarditis
19
Q

What will you see on a ECG of Hyperkalaemia? (4 things)

A
  1. Small / Absent P wave
  2. Increased PR interval
  3. Widened QRS complex
  4. Tall “tented” T waves
20
Q

Why is Hyperkalaemia important to know about?

A

MEDICAL EMERGENCY

21
Q

What are the management options for Hyperkalaemia? (3 things)

A
  1. Calcium gluconate: Protects myocardium
  2. Insulin / Salbutamol (Beta Agonist): Drives Potassium back into intracellular compartment
  3. Stop Potassium Sparing / Containing meds (e.g Spironolactone)
22
Q

Why does Metabolic Acidosis occur in AKI?

A

Bc kidney responsible for Acid-Base balance but impaired in AKI

23
Q

What are the management options for Metabolic Acidosis? (2 things)

A
  1. Sodium bicarbonate
  2. Dialysis
24
Q

What causes Fluid Overload in AKI? (3 things)

A
  1. Aggressive Fluid resus treatment
  2. Oliguria
  3. Sepsis (bc increased capillary permeability)
25
Q

What are the management options for Fluid Overload? (4 things)

A
  1. Oxygen if needed
  2. Fluid restriction
  3. Diuretics (only if symptomatic) (careful bc nephrotoxic)
  4. Renal Replacement Therapy
26
Q

What are the indications for Renal Replacement Therapy in AKI?

A

All 4 AKI complications not responding to meds

27
Q

What are the complications of Renal Replacement Therapy? (3 things)

A
  1. Procecdural Hypotension
  2. Bleeding bc need anticoag req
  3. Altered drug clearance

Y4 Acute Care (31 decks)

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