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Kidney (AKI) > AKI > Flashcards

AKI Flashcards

1
Q

What is the Cockcroft gault equation

A

In the bnf page 22

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2
Q

Limitations of the Cockcroft gault equation

A

Inaccurate in oedema and extreme body weight
Not expressed using standardised reference values
Not validated in paediatric populations
Over estimation of GFR in severe Renal impairment

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3
Q

Limitations of mdrd

A

Only validated for Africans and Caucasians
Not validated in pregnancy
Inaccurate in extreme body weight
Less accurate where eGFR value more than 60ml per min

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4
Q

What are the risk factors of AKI

A

previous aki
Age more than 65
CHF
Liver disease

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5
Q

What are pre renal causes of AKI

A

Hypertension
Atherosclerosis
AHF
MI

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6
Q

What are the intrinsic causes of AKI

A

Tubular damage
Glomerular damage
Interstitial damage

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7
Q

What are post renal causes of AKI

A

Bladder stones
Blocked urinary catheter
Prostate cancer

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8
Q

What are the consequences of AKI

A

Loss of plasma proteins
Inability to excrete hydrogen
Inability to secrete potassium
Accumulation of waste

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9
Q

What is the management of AKI

A

Determine the cause (ie. Post renal pre renal etc).
Monitoring of HR, urine output etc
Correction of hyperkaelemia
Nutritional support

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10
Q

What to do when a patient has hyperkaelaemia and AKI

A

Stop all medication causing hyperkalaemia

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11
Q

How is the mdrd and CG different?

A

Mdrd assumes everyone has a body surface of 1.73m2

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12
Q

How to treat hyperkaelaemia

A

Ion exchange resins
Calcium gluconate- prevents cardiac arrest
Insulin - moves potassium

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13
Q

Why can’t nitrofurantoin be given in Aki and egfr of less than 45

A

Because it targets uti which is after the kidney so won’t get past or work

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14
Q

What is acute kidney injury?

A

A reversible decrease in glomerular filtration rate

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15
Q

What are the main causes of AKI

A

Pre renal: Before kidneys
Intrarenal: within kidneys
Post renal: after kidneys

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16
Q

What are the causes of pre renal AKI

A
  1. Sudden or severe drop in BP (hypotension)
  2. Flow obstruction in kidneys (atherosclerosis or renal artery stenosis)
    3)
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17
Q

What are the causes of intrarenal AKI?

A

-direct damage to kidneys
-inflammation
- infection
- drugs
- autoimmune disease
- acute tubular necrosis

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18
Q

What are the causes of post renal AKI?

A
  • obstruction of urine flow
    -kidney stones
    -bladder injury
    -benign prostatic hyperplasia
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19
Q

What is the most common cause of AKI

A

Intrarenal

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20
Q

What does GFR stand for

A

Glomerular Filtration Rate
- the rate at which the glomerulus filters the blood

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21
Q

What is the role of the afferent arteriole?

A

Carries blood from the renal artery and this blood will be filtered in the glomerulus in the bowman’s capsule

22
Q

What is the role of the efferent arteriole?

A

1.Remaining blood will exit out of the efferent arteriole.
2. The efferent arteriole is situated around the nephron as the vasa recta
3. The vasa recta role is to reabsorb things from the filtrate in the nephron and secrete toxins it doesn’t need
4. It will then join with the Renal vein

23
Q

What is the filtrate that comes out the nephron?

A

Urine output

24
Q

What can post and pre renal AKI cause?

A

Intrarenal issues

25
Q

Why is there a decrease in gromelular rate?

A
  1. vascular changes
    -vasoconstriction
    -endothelial dysfunction
  2. tubular changes
    - damaged cells
    -necrotic debris
    Causes backleak of urine
26
Q

How do you diagnose AKI

A

-Measure the amount of waste product called creatinine. This because high creatinine levels in the blood show filtration is not working effectively

27
Q

What drugs are contraindicated in AKI

A

Remember “ DAMN”

Diuretics
Ace- inhibitors/ ARBS
Metformin
NSAID’s

28
Q

What is creatinine

A

Normal breakdown product of creatine , which is released from muscle tissue.
- freely filtered by glomerulus
- not reabsorbed
- it is secreted

29
Q

What is a recent way to measure creatinine clearance (apart from cockgrauft)

A

Modification of Diet in Renal Disease
(MDRD)

30
Q

What are the symptoms of AKI

A

Vomiting/diarrhoea
Reduce urine production
Nausea
Fatigue
Confusion

31
Q

Diagnosis of AKI

A

1) increase in serum creatinine of 26 micromol/L in 48 hours

2) Increase in serum creatinine of 1.5x of baseline in 7 days

32
Q

Clinical tests for AKI

A

1) serum creatinine testing
2) urine production
3) urea and electrolytes

33
Q

Treatment of AKI

A

1) IV fluid resuscitation
2) withhold nephrotoxic medication (DAMN)

34
Q

Things to take into consideration in AKI

A

-If patient has been treated with trimethoprim, this can cause a false positive result as it increases creatinine
- recent given birth: can cause false positive due to rise in creatinine

35
Q

For a person with AKI, assess:

A

Fluid intake and losses
Heart rate/ blood pressure
Changes in urination pattern

36
Q

What is the mdrd used to calculate?

A

eGFR the glomerular filtration rate

37
Q

What is the CG equation used to estimate?

A

Creatine clearance

38
Q

What is MDRD adjusted for

A

Age
Gender
Race
NOT WEIGHT

39
Q

What does the MDRD assume

A

That a normal body surface area is 1.73m2

40
Q

Which equation is better for estimating drug dosing?

A

Recommended to use CG equation

41
Q

Can you still use egfr (MDRD)for drug dosing

A

Yes

42
Q

In which cases should eGFR not be used for calculating drug doses:

A

-Patients with extremes of body weight or muscle mass
- Renally cleared drugs with narrow therapeutic index (digoxin, DOACS, theophylline, lithium and vancomycin)
- rapidly changing renal function e.g AKI

43
Q

What are the units for eGFR (MDRD formula)

A
  • should always be a whole number (round to nearest whole )
  • ml/min/1.73m2
44
Q

Complications of AKI

A

Hyperkaelaemia
Metabolic acidosis
Sodium imbalance

45
Q

Management of AKI

A

Determine AKI (post renal etc.)
Correct any hyperkaelaemia and / or metabolic acidosis
Optimise fluid balance

46
Q

How to optimise fluid balance?

A

-hypovolaemia (sodium chloride 0.9%)
- hypernatraemia (dextrose 5%)

47
Q

How to treat hyperkalaemia in AKI?

A

STOP all drugs that cause hyperkalaemia e.g ACE- inhibitors, ARBs, aldosterone antagonists

48
Q

How to adjust drug dose in AKI

A

Reduce dose - causing drug concentration to return to desired level.
Increase dose interval - skipping every other dose causing drug conc to fall to desired level

49
Q

Ways to prevent AKI

A

Maintain adequate systolic BP and hydration
Avoid nephrotoxic drugs
Monitor renal function and adjusting drug treatment

50
Q

What is the drug “sick day” guidance

A

Advising temporary cessation of drugs that have potential to impair renal function when patients at risk of AKI
E,g ACE- inhibitors, ARBs, Diuretics , NSAID’s

Kidney (AKI) (1 decks)

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