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MSRA renal > AKI > Flashcards

AKI Flashcards

1
Q

What criteria is used to diagnose AKI?

A

rise in creatinine >26 in 48hrs
rise in creatinine >50% in 7 days
decrease in UO <0.5ml/kg/hr for >6hrs

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2
Q

what are KDIGO criteria for stage 1 AKI?

A

increase in creatinine 1.5-1.9x baseline
or increase in cr by >26.5
or reduction in UO <0.5ml/kg/hr for >6hrs

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3
Q

what are KDIGO criteria for stage 2 AKI?

A

increase in cr to 2-2.9x baseline
or reduction in UO to <0.5ml/kg/hr for >12hrs

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4
Q

what are KDIGO criteria for stage 3 AKI?

A

increase in cr to >3x baseline
or increase in creatinine to ?353.6
or reduction in UO to <0.3ml/kg/hr for >24hrs
or intiation of kidney replacement therapy
or if <18yo decrease in eGFR to <35

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5
Q

when do you need to refer to a nephrologist?

A

renal transplant
ITU patient w unknown cause of AKI
vasculitis, glomerulonephritis
tubulointerstitial nephritis
myeloma
AKI w no known cause
inadequate response to rx
complications of AKI
stage 3 AKI
CKD stage 4 or 5
qualify for renal replacement hyperkalaemia/metabolic acidosis/complications of uraemia/fluid overload

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6
Q

what can increase the risk of AKI?

A

emergency surgery ie risk of sepsis or hypovolaemia
intraperitoneal surgery
CKD eGFR<60
diabetes
HF
>65yo
liver disease
use of nephrotoxic drugs
- NSAIDs
- aminoglycosides eg gentamicin
- ACEi/ARB
- diuretics

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7
Q

what are the pre-renal causes of AKI?

A
  1. shock- inadequate renal perfusion- dehydration, haemorrhage, heart failure, sepsis

kidneys act to concentrate urine + retain sodium- high urine osmolality >500, low urinary sodium <20

  1. renovascular compromise
    - RAS
    - toxins: NSAIDs, ACEi
    - thrombosis
    - hepatorenal syndrome
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8
Q

what are the renal causes of AKI?

A

ATN
TIN
GN

most common- ATN (acute tubular necrosis)
damage to tubular cells due to prolonged ischaemia/toxins
kidneys can no longer concentrate urine or retain sodium- low urine osmolality<350, high urine sodium >40

rare causes- acute glomerulonephritis, acute interstitial nephritis, nephritic syndrome

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9
Q

what are the causes of ATN?

A

ischaemia: shock, HTN, HUS, TTP

direct nephrotoxins: drugs, contrast, hb

acutely- drug hypersenstiivity

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10
Q

what are post-renal causes of AKI?

A

SNIPPIN
Stone
neoplasm
inflammation- stricture
prostatic hypertrophy
posterior urethral valves
infection- TB, schisto
neuro- post-op, neuropathy

urinary tract obstruction results in hydronephrosis on USS

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11
Q

what is the cause of isolated rise in urea?

A

decreased flow eg hypoperfusion/dehydration

decreased flow leads to increased urea reabsorption (dehydration)

increased urea with protein meal- upper GI bleed, supplements

decreased urea with hepatic impairment (urea is produced from ammonia by liver in ornithine cycle)

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12
Q

what results in rise in both urea and creatinine?

A

decreased filtration ie renal failure

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13
Q

what is creatinine clearance?

A

volume of blood that can be cleared of a substance in 1 minute

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14
Q

how can people present wtih renal failure?

A

uraemia eGFR<15
protein loss + Na retention
fluid overload
acidosis
hyperkalaemia
anaemia
vitamin D deficiency

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15
Q

what are the symptoms of uraemia?

A

pruritus
n+v, anorexia, wt loss
lethargy
confusion
restless legs
metallic taste
paraesthesia- neuropathy
bleeding
chest pain- serositis
hiccoughs

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16
Q

what are the signs of uraemia?

A

pale sallow skin
striae
pericardial/pleural rub
fits
coma

17
Q

what are the symptoms of hypernatraemia/protein loss?

A

polyuria, polydipsia
oliguria, anuria
SOB

18
Q

what are the signs of hypernatraemia/protein loss?

A

oedema
raised JVP
HTN/hypotension

19
Q

what are the symptoms of acidosis?

A

SOB
confusion

20
Q

what are the signs of acidosis?

A

kussmaul respiration

21
Q

what are the symptoms of anaemia?

A

SOB
lethargy
faint
tinnitus

22
Q

what are the signs of anaemia?

A

pallor
tachycardia
ESM at apex

23
Q

what are the symptoms of vitamin D deficiency?

A

bone pain
fractures

24
Q

what are the signs of vitamin D deficiency?

A

osteomalacia
- looser’s zones (pseudo fractures)
- cupped metaphyses

25
Q

what are the symptoms of hyperkalaemia?

A

palpitations
chest pain
weakness

26
Q

what are the signs of hyperkalaemia?

A

tall tented T waves
flattened p waves
prolonged PR interval
widened QRS
sine-wave pattern-> VF

27
Q

what are the signs of fluid overload?

A

oedema
high or low BP
S3 gallop
raised JVP

28
Q

what is involved in clinical assessment of AKI?

A

assess for:
1. acute or chronic
2. volume depletion
3. GU tract obstruction
4. rare cause

29
Q

what suggests chronic features of AKI?

A

hx of comorbidity- DM. HTN
long duration of symptoms
previously abnormal blood results

30
Q

what suggests volume depletion?

A

postural hypotension
JVP not raised
tachycardia
poor skin turgor
dry mucous membranes

31
Q

what suggests GU tract obstruction?

A

suprapubic discomfort
palpable bladder
enlarged prostate
catheter
complete anuria- rare in ARF

32
Q

what are rare causes of AKI?

A

associated with proteinuria +/- haematuria
vasculitis- rash, arthralgia, nosebleed

33
Q

what investigations are needed in AKI?

A

bloods- FBC, UE, LFT, glucose, clotting, Ca, ESR

ABG: hypoxia (oedema), acidosis, hyperK

GN screen- if cause unclear

urine- dip, MCS, chemistry (UE, PCR, osmolality, BJP)

ECG- hyperkalaemia

CXR- pulmonary oedema

renal US- renal size, hydronephrosis

34
Q

what would suggest a pre-renal cause of AKI?

A

high osmolality
low urinary Na

because urine is concentrated and Na is reabsorbed

35
Q

what are indications for acute dialysis?

A

persistent hyperkalaemia?7
refractory pulmonary oedema
symptomatic uraemia- encephalopathy, pericarditis
severe metabolic acidosis ph<7.2
poisoning eg aspirin

36
Q

what are exogenous causes of nephrotoxicity?

A

NSAIDs
ACEi
immunsuppressants- ciclosporin, tacrolimus
contrast media
anaesthetics- enflurane
antimicrobials
- aminoglycosides
- vanc
- aciclovir
- sulphonamides
- tetracycline
- amphotericin

MSRA renal (26 decks)

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