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FINALS RENAL + UROLOGY > AKI > Flashcards

AKI Flashcards

1
Q

what is an AKI

A

rapid onset reduction in renal injury from an insult to kidneys

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2
Q

RF for AKI

A

CKD // other chronic disease eg HF // nephrotoxic meds // iodinated contrasts // 65+ // oliguria

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3
Q

nephrotoxic meds

A

NSAIDs, aminoglucosides (gentamicin), ACEi, ARBs, diuretics

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4
Q

definition oliguria

A

UO <0.5ml/kg/hr

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5
Q

symptoms AKI

A

reduced UO // pulmonary + peripheral oedema // uraemia –> itch, pericarditis // arrythmia

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6
Q

diagnosing AKI

A

rise in creatine of >26 in 48 hours // 50%+ rise in creatine over 7 days // decreased UO to <0.5ml/kg/hr

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7
Q

invx needed in AKI

A

urinalysis, ECG, renal USS within 24 hours

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8
Q

what drugs should be stopped in AKI as they worsen eGFR

A

NSAIDs // aminoglycosides // ACEi + ARBs // diuretics

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9
Q

when can aspirin be continued in AKI

A

aspirin cardiac dose 75mg

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10
Q

what meds should be stopped in AKI as they can build

A

metformin, lithium, digoxin

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11
Q

meds safe in AKI

A

paracetamol, warfarin, statin, clopidogrel, aspirin 75, BB

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12
Q

mx of hyperkalaemia in AKI

A

IV calcium gluconate (stabalise cardiac membrane) // IV insulin + dex or salbutamol // calcium resonium, loop diuretic, dialysis

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13
Q

AKI indications for dialysis

A

urea >40 –> (pericarditis, encephalopathy) // pulm oedema // hyperkaaemia // acidosis

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14
Q

what is stage 1 AKI

A

creatine rise 1.5-1.9x // OR oliguria for >6 hours

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15
Q

what is stage 2 AKI

A

creatine rise 2-2.9x // OR oliguria >12 hours

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16
Q

what is stage 3 AKI

A

creatine rise 3x OR creatine >353 // OR urine <0.3ml/kg/hr for >24 hours

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17
Q

most common cause of AKI

A

pre-renal

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18
Q

causes pre-renal AKI

A

hypovolaemia (diarrhoea, vomiting, reduced CO, sepsis) // renal artery stenosis

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19
Q

causes of renal AKI

A

glomerulonephritis // ATN // acute interstitial nephritis // rhabdo // tumour lysis // drug toxins // contrast

20
Q

causes post-renal AKI

A

(obstructive) kidney stone // BPH // external compression

21
Q

what is most common cause of AKI

A

acute tubular necrosis

22
Q

what causes ischaemic (pre-renal) ATN

A

shock or sepsis

23
Q

what causes nephrotoxic (intrinsic) ATN

A

ahminoglycosides // rhabdo –> myoglobin // radiocontrast // lead

24
Q

symptoms ATN

A

AKI - raised urea, creatinine, potassium // muddy brown urine

25
Q

phases of ATN

A

oliguric –> polyuric –> recovery

26
Q

biopsy ATN

A

tubular epithelial necrosis // dilation of tubules

27
Q

sodium in pre-renal AKI (urine, osmolarity, fractional excretion, response to fluid)

A

(holds on to Na to preserve volume) urine na <20 // osmolality >500 // excretion <1% // raised urea:creatine // good response to fluid

28
Q

sodium in renal ATN (urine, osmolarity, fractional excretion, response to fluid)

A

urine Na >40 // osmolality <350 // sodium excretion >1% // bad response to fluid // brown pee

29
Q

what is contrast media nephrotoxicity

A

increase creatinine >25% within 3 days administration

30
Q

RF contrast media nephrotoxicity

A

renal impairement // 70+ // dehydrated // CF

31
Q

examples of procedures to contrast media nephrotoxicity

A

CT + contrast // PCI

32
Q

prevention contrast media nephrotoxicity

A

IV saline 12 hours pre + post procedure

33
Q

what drug should be withheld after contrast to prevent AKI

A

metformin

34
Q

what causes acute interstitial nephritis (type of AKI)

A

penicillin, abx, NSAIDs, allopurinol // SKE

35
Q

symptoms acute interstitial nephritis

A

fever, rash, arthralgia, renal impairment, hypertension

36
Q

invx acute interstitial nephritis

A

eosinophilia // sterile pyuria // white cells

37
Q

what is tubulointerstitial nephritis with uveitis + who gets it

A

young females // fever, weight loss, painful eyes // urinalysis has leukocytes + protein

38
Q

common presentation rhabdomyolysis

A

fall or prolonged seizure –> AKI

39
Q

features rhabdo

A

v raised creatine // raised CK // myoglobinuria // low Ca // raised phosphate + K // met acidosis

40
Q

causes rhabdo

A

seizure // collapse // ecstasy // McArdles // statins (+ clarithromycin)

41
Q

mx rhabdo

A

IV fluids +/- urinary alkalinization

42
Q

triad HUS

A

AKI + microangiopathic haemolytc anaemia + thrombocytopenia

43
Q

what causes HUS

A

shiga E.coli 0157 // (pneumococcal, HIV, SLE, primary)

44
Q

what causes primary HUS

A

complement dysregulation

45
Q

invx HUS

A

FBC: Hb <9 + negative coombs // U+E // stool culture + PCR

FINALS RENAL + UROLOGY (16 decks)

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