AKI

Question 1

what is an AKI

Answer 1

rapid onset reduction in renal injury from an insult to kidneys

Question 2

RF for AKI

Answer 2

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

Question 3

nephrotoxic meds

Answer 3

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

Question 4

definition oliguria

Answer 4

UO <0.5ml/kg/hr

Question 5

symptoms AKI

Answer 5

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

Question 6

diagnosing AKI

Answer 6

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

Question 7

invx needed in AKI

Answer 7

urinalysis, ECG, renal USS within 24 hours

Question 8

what drugs should be stopped in AKI as they worsen eGFR

Answer 8

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

Question 9

when can aspirin be continued in AKI

Answer 9

aspirin cardiac dose 75mg

Question 10

what meds should be stopped in AKI as they can build

Answer 10

metformin, lithium, digoxin

Question 11

meds safe in AKI

Answer 11

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

Question 12

mx of hyperkalaemia in AKI

Answer 12

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

Question 13

AKI indications for dialysis

Answer 13

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

Question 14

what is stage 1 AKI

Answer 14

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

Question 15

what is stage 2 AKI

Answer 15

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

Question 16

what is stage 3 AKI

Answer 16

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

Question 17

most common cause of AKI

Answer 17

pre-renal

Question 18

causes pre-renal AKI

Answer 18

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

Question 19

causes of renal AKI

Answer 19

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

Question 20

causes post-renal AKI

Answer 20

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

Question 21

what is most common cause of AKI

Answer 21

acute tubular necrosis

Question 22

what causes ischaemic (pre-renal) ATN

Answer 22

shock or sepsis

Question 23

what causes nephrotoxic (intrinsic) ATN

Answer 23

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

Question 24

symptoms ATN

Answer 24

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

Question 25

phases of ATN

Answer 25

oliguric --> polyuric --> recovery

Question 26

biopsy ATN

Answer 26

tubular epithelial necrosis // dilation of tubules

Question 27

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

Answer 27

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

Question 28

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

Answer 28

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

Question 29

what is contrast media nephrotoxicity

Answer 29

increase creatinine >25% within 3 days administration

Question 30

RF contrast media nephrotoxicity

Answer 30

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

Question 31

examples of procedures to contrast media nephrotoxicity

Answer 31

CT + contrast // PCI

Question 32

prevention contrast media nephrotoxicity

Answer 32

IV saline 12 hours pre + post procedure

Question 33

what drug should be withheld after contrast to prevent AKI

Answer 33

metformin

Question 34

what causes acute interstitial nephritis (type of AKI)

Answer 34

penicillin, abx, NSAIDs, allopurinol // SKE

Question 35

symptoms acute interstitial nephritis

Answer 35

fever, rash, arthralgia, renal impairment, hypertension

Question 36

invx acute interstitial nephritis

Answer 36

eosinophilia // sterile pyuria // white cells

Question 37

what is tubulointerstitial nephritis with uveitis + who gets it

Answer 37

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

Question 38

common presentation rhabdomyolysis

Answer 38

fall or prolonged seizure --> AKI

Question 39

features rhabdo

Answer 39

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

Question 40

causes rhabdo

Answer 40

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

Question 41

mx rhabdo

Answer 41

IV fluids +/- urinary alkalinization

Question 42

triad HUS

Answer 42

AKI + microangiopathic haemolytc anaemia + thrombocytopenia

Question 43

what causes HUS

Answer 43

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

Question 44

what causes primary HUS

Answer 44

complement dysregulation

Question 45

invx HUS

Answer 45

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