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weenal > aki > Flashcards

aki Flashcards

1
Q

aki consequences

A

increased mortality (over double)
cost
increased length of hospital stay
increased creatinine

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2
Q

def of aki

A

abrupt (<48hrs) reduction in kindye function defined as

  • absolute increase in serum creatinine by > 26.4 micrmol/l

OR increase in creatinine by >50%

OR reduction in UO

can only be applied following adequate fluid resuscitation & exclusion of obstruction

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3
Q

KDIGO staging classification

A
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4
Q

risk factors for AKI

A

older age

ckd

diabetes

cardiac failure

liver disease

pvd

previous aki

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5
Q

risk faCtors - exposure

A

hypotension

hypovolaemia

sepsis

deteriorating NEWS

recent contrast

exposure to certain meds

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6
Q

causes of aki

A

pre renal (functional)

renal (structural)

post renal (obstructional)

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7
Q

pre-renal aki causes

A

HYPOvolaemia
- haemorrhage
- volume depletion (e.g D&V, burns)

HYPOtension
- cardiogenic shock
- distributive shock (e.g. sepsis, anaphylaxis)

renal hypoperfusion
- NSAIDs / COX-2
- ACEi / ARBs
- hepatorenal syndrome

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8
Q

pre renal aki

A

reversible volume depletion leading to oliguria & increase in creatinine

normal urine output
- 0.5ml/kg/hr
- 30mls/hr if 60kg or 50mls/hr if 100kgs

oliguria
- <0.5mls/kg/hr

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9
Q

renal perfusion

A

kidneys are 0.5% of body weight
kidneys receive 20% CO

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10
Q

untreated pre renal AKI leads to ______

A

acute tubular necrosis

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11
Q

acute tubular necrosis

A

comment form of aki in hospital

due to a combination of factors leading to decreased renal perfusion

common causes include sepsis and severe hydration

other important causes include rhabdomyolysis and drug toxicity

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12
Q

treatment of pre renal aki

A

assess for hydration
- obs (BP, HR, UO)
- jvp, cap refill, oedema
- pulm oedema

fluid challenge for hypovolaemia
- crystalloid (0.9% nacl) or colloid (gelofusin)
- DO NOT USE 5% dextrose
- give bolus of fluid then reassess and repeat as necessary
- if > 1000mls IN and no improvement, seek help

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13
Q

renal aki

A

diseases cauasing inflammation or damage to cells causing aki

split by structure
- blood vessels
- glomerular disease
- interstitial injury
- tubular injury

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14
Q

causes of renal aki

A
  1. vascular
    - vasculitis, renovascular disease
  2. glomerular
    - glomerulonephritis
  3. interstitial nephritis
    - drugs
    - infection (TB)
    - systemic (sarcoid)
  4. tubular injury
    - ischaemia (prolonged renal hypoperfusion)
    - drugs (gentamicin)
    - contrast
    - rhabdomyolysis
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15
Q

signs & symptoms aki

A
  1. non specific
    - constitutional (anorexia, weight loss, fatigue, lethary)
    - N&V
    - itch
    - fluid overload (oedema, sob)
  2. signs
    - fluid overload (inc HTN, oedema, pulm oedema, pleural & pulm effusions)
    - uraemia incl itch, pericarditis
    - oliguria
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16
Q

clues to renal cause

A
  • hx (sore throat, rash, joint pains, d&v, haemoptysis)
  • urinalysis
  • drug chart
  • recent contrast
  • blood results (eosinophilia, ck)
  • vascular bruits
17
Q

aki initial invstgns

A
  • U&Es (high K?)
  • FBC & coag screen (clotting, Hb)
  • urinalysis (haematoproteinuria)
  • uss (obstruction size?)
  • immunology (ANA, ANCA, GBM)
  • protein electrophoresis & BJP (myeloma)
18
Q

further treatment of aki

A
  • good perfusion pressure (fluid resus, if still not adequte BP - inotropes/vasopressors)
  • treat underlying cause (ABs if sepsis)
  • stop nephrotoxics
  • dialysis if anuric & uraemia (can require urgent dialysis)
19
Q

life threatening comps of aki

A
  • hyperkalaemia
  • fluid overload (pulm oedema)
    diuretics dont work help!!
  • severe acidosis (ph<7.15)
  • uraemic pericardial effusion
  • severe uraemia (ur > 40)
20
Q

post renal aki (obstruction)

A

aki due to obstruction of urine flow leading to back pressure (hydronephrosis) and loss of conc ability

21
Q

obstruction causes

A

stones, cancers, strictures, extrinsic pressure

22
Q

treatment post renal

A

relieve obstruction
- catheter
- nephrostomy

  • refer to urology if ureteric stenting required
23
Q

hyperkalaemia values and assessment

A

> 5.5
life threating = >6.5

ECG or muscle weakness

24
Q

ECG hyperkalaemia

A

peaked T waves, flattened P wave, prolonged PR interval, depressed ST segment, peaked T wave, atrial standstill, prolonged QRS duration, further peaking T waves, sine-wave pattern

25
Q

treatment

A
  • cardiac monitor & IV access
  • protect myocardium (10mls 10% calcium gluconate 2-3 mins)
  • move K+ back into cells (insulin actrapid 10 units) w/ 50mls 50% dextrose (30 mins)
  • prevent absorption from GI tract (calcium resonium) not in acute setting!!
26
Q

urgent indics for HD

A
  • hyperkalaemia (>7, >6.5 unresponsive to medical therapy)
  • severe acidosis (ph <7.15)
  • fluid overload
  • urea >40, pericardial rub/effusion
27
Q

aki prognosis

A
  • mortality
  • recovery of renal function
    (either none, full, or full w/ prog. CKD)
28
Q

aki sick day rules

A

look up later

weenal (18 decks)

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