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Renal + Urology > AKI > Flashcards

AKI Flashcards

1
Q

What constitutes AKI?

A

serum creatinine >26.5 micromol/l in 48 hours

serum creatinine >1.5xbaseline within last 7 days

urine output <0.5ml/kg/hr for 6h

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2
Q

Stage 1 AKI criteria

A

increase >26micromol/L within 48h or 1.5-1.9xbaseline creatinine

<0.5ml/kg/hr for >6h

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3
Q

Stage 2 AKI criteria

A

increase >2-2.9x reference creatinine
<0.5ml/kg/hr >12h

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4
Q

Stage 3 AKI criteria

A

increase >3x reference creatinine or increase >354micromol/L or commenced on RRT

<0.3 ml/kg/hr for >24h or anuria for 12h

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5
Q

Pre renal causes of AKI

A

hypovolaemia
sepsis –> shock
nephrotoxic drugs
renovascular disease
left ventricular dysfunction

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6
Q

Factors that affect renal perfusion (GFR)

A

cardiac output (pump)
effective circulatory volume (blood)
peripheral vascular resistance (BP)

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7
Q

Patients at high risk of AKI

A

elderly
arteriosclerosis (HTN, DM)
pre-existing renal disease
underlying cardiovascular disease
ARB/ACE-i/NSAID/anti-hypertensives/diuretics

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8
Q

AKI management

A

IV access and bloods (CRP + cultures)
ABG/VBG
ECG
wound swabs
urine dip and input/output monitoring
CXR

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9
Q

Mild hyperkalaemia ECG changes (5.5-6.5)

A

tall peaked T waves with narrow base

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10
Q

Moderate hyperkalaemia ECG changes (6.5-8)

A

peaked T waves
prolonged PR interval
decreased amplitude of P waves
widening QRS complex

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11
Q

Severe hyperkalaemia ECG changes (>8)

A

absence P wave
progressive widening of QRS complex
eventual sine wave pattern
VF
asystole

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12
Q

Key treatment priorities in AKI

A

treat hyperkalaemia (insulin-dextrose, calcium gluconate, IV bicarbonate)
IVF resus
treat infection
stop nephrotoxins

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13
Q

How to assess fluid balance

A

peripherally:
- pulse, capillary refill
- warm/vasodilated/hyperdynamic
- weak/thready/cool

centrally:
- JVP
- BP (postural)

skin turgor/mucus membranes

auscultate chest

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14
Q

Post-renal causes of AKI

A

obstruction:
- intrinsic = intraluminal (stone, blood clot, papillary necrosis), intramural (bladder tumour, urethral stricture)

  • extrinsic = prostate, pelvic, retroperitoneal fibrosis
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15
Q

Post-renal AKI treatment

A

urinary catheter (SPC)
polyuric phase - careful input/output monitoring, IVF
USS renal tract
treat underlying infection
check PSA/DRE

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16
Q

Intrinsic renal causes of AKI

A

acute tubular necrosis
acute glomerulonephritis
acute tubular interstitial nephritis
acute vascular

17
Q

What causes acute tubular necrosis?

A

ischaemia - any cause of renal hypoperfusion (hypovolaemia, hypotension)

toxins:
- endogenous = myoglobin (rhabdomyolysis), haemoglobin (massive haemolysis), myeloma (light chains), uric acid (tumour lysis syndrome)

  • exogenous = contrast, antibiotics (aminoglycosides, amphotericin B), cisplatin
18
Q

Tubulointerstitial nephritis clinical features

A

fever
arthralgia
skin rash
AKI
eosinophilia
eosinophiluria

19
Q

Tubulointerstitial nephritis treatment

A

withdraw offending drug, treat infection
improvement: observe
no improvement/worsening - corticosteroids

20
Q

Causes of tubulointerstitial nephritis

A

drugs:
- abx (penicillins, sulphonamides, cephalosporins)
- antiretrovirals
- NSAIDs
- allopurinol
- PPIs, cimetidine
- diuretics - furosemide/thiazides

infection
autoimmune (TINU, sjogrens, SLE)

21
Q

Key features of nephrotic syndrome

A

proteinuria >3.5g/day
hypoalbuminaemia
oedema
hyperlipidaemia
lipiduria
(raises risk of thromboembolic disease and infection)

22
Q

What does nephrotic syndrome increase the risk of?

A

thromboembolic disease
infection

23
Q

Nephrotic syndrome causes

A

minimal change
membranous
mesangiocapillary
diabetes
FSGS
amyloidosis
HIV
lupus

24
Q

Key features of nephritic syndrome

A

haematuria
proteinuria (<3g/day)
oedema
oliguria
hypertension

25
Q

Nephritic syndrome causes

A

IgA
HSP
small vessel vasculitis (GPA, MPA)
Goodpasture’s
post-infectious
mesangiocapillary
lupus

26
Q

Urgent dialysis indications

A

resistant hyperkalaemia
resistant pulmonary oedema
uraemic - encephalopathy, pericarditis
acidosis
drug overdose

27
Q

Mnemonic to help remember AKI causes

A

STOP

Sepsis
Toxins
Obstruction
Parenchyma

Renal + Urology (37 decks)

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