AKI

Question 1

Define AKI in serum creatinine levels.

Answer 1

Increase in serum creatinine >26umol/L within 48HR
1.5-x baseline within 7 days
Urine vol <0.5 ml/kg/h for 6 HR.

Question 2

Pre renal causes of AKI

Answer 2

(decrease renal perusion, alterations in autoregulation of renal vasculature.
1. Hypovolaemic, cardiogenic or distributive shock
2. Sepsis
3. Renal artery stenosis
4. Drugs - NSAIDs, ACEi/ARBs
5. Haemorrhage
6. liver and cardiac failure.

Question 3

Intrisinc causes of AKI

Answer 3

(Affects glomeruli, tubules, interstitium, renal vessels)
1. Nephrotoc syndrome, glomerulonephritis
Acute interstial nephritis
Acute tubular necrosis
Renal vein thrombosis,
TTP, vasculitis.

Question 4

Post renal causes of AKI

Answer 4

(obstruction to urinary outflow anywhere along urinary tract)
* kidney stones
Tumour
Benign prostatic hypertrophy

Question 5

Fluid overload signs

Answer 5

Oedema,
Hypertension
Puomonary oedema

Question 6

Other signs of aki

Answer 6

Sepsis
Rashes
Fatigue
Vomiting
Nausea
Pruritis

Question 7

Basic Inv of aki

Answer 7

• Urine dipstick
  *bladder scan
  *US KUB
  ABG

BLOODS
ECG
CXR

Question 8

Indications for acute dialysis or haemofiltration.

Answer 8

Uraemi
Electrolyte
Intoxication
Odeoma

Question 9

Management of aki

Answer 9

ABCDE
1. Volume assesment
2. Sepsis screen
3. Toxins
4. Obstruction
5. Hyperkalaemia
6.Monitor

Question 10

What drugs should be stopped in AKI

Answer 10

ACEi
ARBS
NSAIDS
AMINOGLYCOSIDE
DIURETICS
Metformin
Digoxin
Lithium

Question 11

Pathology of pre renal cause of aki

Answer 11

Reduction in renal perfusion -> leads to decreased glomerular filtration -> triggering the release of renin, aldosterone, and antidiuretic hormone to conserve fluid and maintain perfusion pressure.
Prolonged prerenal states, progress to ATN, causing intrinsic renal damage.

Question 12

Intrisinc causes pathology. (5) in aki

Answer 12

.

Glomerulopathies: Immune-mediated injury to the glomeruli results in inflammation filtering capacity of the glomerulus.

Interstitial Diseases: Inflammatory infiltration of the interstitium disrupts tubular function and can cause tubular atrophy.

Vascular Causes: renal vasculature damage -> ischaemic injury, inflammation, damaging the renal parenchyma.

Question 13

Postrenal aki pathology

Answer 13

Obstruction results in increased intratubular pressure-> increases tubular reabsorption prolonged -> diminish (GFR).
Backflow of urine -> cause tubular damage -> expose the kidney to infection.

Question 14

Presentation of pt w rhabdomyolysis

Answer 14

patient who had a fall or prologned sezuires

Question 14

Rhabdomyolysis iv + Tx

Answer 14

AKI w raised creatinine
raised CK
hypocalecamia - myoglbin bind to Ca
Phosphate Increase

TX
IV fluids - maintain good urine output.

Question 15

Pathophysiology of ATN

Answer 15

Acute Tubular Necrosis:
due to prolonged prerenal states, leading to epithelia cell death. Cells can form casts, obstructin tubules.

Question 16

basic pathophysiology of glomerulopathies

Answer 16

Glomerulopathies: Immune-mediated injury to the glomeruli results in inflammation filtering capacity of the glomerulus.

Question 17

basic pathophysiology of interstital diseases - related to aki

Answer 17

Interstitial Diseases: Inflammatory infiltration of the interstitium disrupts tubular function and can cause tubular atrophy.