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EDIC - Fundamentals of ICU > AKI > Flashcards

AKI Flashcards

1
Q

Location of the kidneys?

A

Retroperitoneal against the posterior abdominal wall

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2
Q

Proportion of cardiac output received by the kidneys?

A

20-25%

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3
Q

Sections of the nephron within the cortex?

A
  • Glomerulus
  • Bowmann’s capsule
  • Convoluted tubules
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4
Q

Sections of the nephron within the medulla?

A
  • Loop of Henle
  • Collecting duct
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5
Q

Causes of AKI can be divided into ?

A
  • Pre-renal
  • Renal
  • Post-renal
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6
Q

What are the causes of pre-renal AKI? This is 20% of AKI!

A
  • Renal hypoperfusion
  • Hypovolaemia or hypotension
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7
Q

What is the consequence of AKI?

A
  • Retention and accumulation of waste products
  • Dysregulation of ECF volume
  • Electrolyte disturbances
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8
Q

What is the functions of the different parts of the nephron?

A
  • Bowman’s capsule & glomerulus - Ultrafiltration
  • Proximal tubule - Selective re-absorption
  • Loop of Henle - Osmoregulation
  • DCT - selective re-absorption
  • Collecting duct - Osmoregulation
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9
Q

What occurs in proximal tubule selective re-absorption ?

A
  • Glucose
  • Amino acids
  • Urea
  • Sodium
  • Potassium
  • Phosphate
  • Calcium
  • Magnesium
  • Water
  • Bicarbonate
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10
Q

What are osmoregulated in the loop of henle? Ascending loop!

A
  • Sodium
  • Potassium
  • Magnesium
  • Calcium
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11
Q

What is selectively re-absorbed in the DCT?

A
  • Urea
  • Sodium
  • Calcium
  • Magnesium
  • Water
  • Bicarbonate
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12
Q

What are osmoregulated in the loop of collecting duct ?

A
  • Sodium
  • Water
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13
Q

What are the functions of the kidney ?

A
  • Maintenance of fluid balance
  • Electrolyte regulation
  • Acid-base balance
  • Excretion of waste products - Ur, Cr, uric acid & NH
  • Excretion & metabolism of drugs
  • BP control via RAA system
  • Vitamin D activation
  • Production of erythropoietin
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14
Q

How is renal function assessed?

A

By assessment of GFR

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15
Q

What is GFR

A

This is the rate at which protein free plasma is filtered from glomeruli into the bowman’s capsule per unit time

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16
Q

What methods can be used in assessing GFR?

A
  • Directly - Insulin
  • Indirectly - Creatinin
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17
Q

What are the causes of renal AKI? This is 70% of AKI!

A

This is due to structural damage to the kidney

  • Acute tubular necrosis
  • Glomerulonephritis
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18
Q

Definition of stage 1 AKI?

A
  • Increase in creatinine 1.5-1.9 times baseline
  • Increase by > 26.5 micro mole/L
  • Reduction in UO < 0.5 ml/kg/hr for 6-12 hrs
19
Q

Definition of stage 2 AKI?

A
  • Increase of creatinine 2 - 2.9 of baseline
  • Reduction in UO of < 0.5 ml/kg/hr for > 12hrs
20
Q

Definition of stage 3 AKI?

A
  • Increase in creatinine > 3 times baseline
  • Initiation of RRT
  • In patient < 18 with eGFR < 35 ml/min/1.73m2
  • Reduction in UO < 0.3ml/kg/hr for 24 hours
  • Anuria for 12 hrs
21
Q

Aetiologies of pre-renal AKI?

A
  • Hypovolaemia
  • Hypotension
  • Afferent arteriole constriction (ACEI, Renal artery stenosis, hepato-renal syndrome)
22
Q

Aetiologies of renal AKI?

A
  • Acute tubular necrosis (Ischaemia, drug, Rhabdomyolysis )
  • Glomerulonephritis (Acute interstitial nephritis, drugs)
  • Others: SLE , TB Sarcoidosis
23
Q

Aetiologies of post-renal AKI?

A
  • Renal calculi
  • Ureteric (Stones, stricture, tumour or clots)
  • Extrinsic pressure - Cancer
24
Q

What are the complications of AKI?

A
  • Metabolic acidosis
  • Hyperkalaemia
  • Fluid overload
  • Hypocalcaemia
  • Low phosphate
  • Anaemia
  • Uraemia
25
Q

What are the symptoms of uraemia?

A
  • ## Encephalopathy
26
Q

What are the common indications for RRT?>

A
  • Fluid OL
  • Hyperkalaemia
  • Metabolic acidosis
  • Uraemia
  • Medication toxicity - Lithium
27
Q

What is the basic principle of RRT?>

A
  • Diffusion - Haemodialysis
  • Convection - Haemofiltration
28
Q

Types of RRT?

A
  • Intermittent
  • Hybrid
  • Continuous
29
Q

What are the types of intermittent dialysis ?

A
  • IHD - Intermittent haemodialysis
  • IUF - Isolated ultrafiltration
30
Q

What are the types of hybrid dialysis?

A
  • SLEDD - Sustained (or slow) low efficiency daily dialysis
  • SLEDD-F - Sustained (or slow) low efficiency daily dialysis with filtration
31
Q

What are the types of continuous dialysis?

A
  • CVVHF
  • CVVHD
  • CVVHDF
  • SCUF - Slow continuous ultrafiltration
32
Q

What are the advantages of continuous RRT?

A
  • Haemodynamic stability
  • Stable volume control
  • Stable control of biochemistry
  • Stable intracranial pressure
33
Q

What are the dis-advantages of continuous RRT?

A
  • Patient not mobile during treatment
  • Anticoagulation required
  • Expensive
  • Risk of clotting
34
Q

What are the advantages of intermittent RRT?

A
  • Shorter duration
  • Rapid electrolyte correction
  • Rapid correction of fluid OL
  • Minimal use of anticoagulation
  • Removal of dialysable drugs
35
Q

What are the dis-advantages of intermittent RRT?

A
  • Cerebral oedema - Rapid fluid removal
  • Hypotension
36
Q

Mechanism of action of haemodialysis?

A
  • Diffusion
  • Solutes across semi-permeable membrane
  • Diffusion gradient dependent on solute
37
Q

Mechanism of action of haemofiltration ?

A
  • Convection
  • Bulk flow of solutes across semi-permeable membrane
  • Dependent on transmembrane pressure gradient
38
Q

Determinants in prescribing RRT?

A
  • Patient’s needs
  • Local availability and protocols
  • Anti-coagulation
39
Q

Types of anticoagulation used in RRT?

A
  • Heparin
  • Citrate - Used within filter in the machine
40
Q

What is the standard starting prescription for RRT ?

A

25-35ml/kg/hr

41
Q

What is the rate of fluid removal ?

A

Ranges from 0-250ml/hr

42
Q

What is the process of fluid removal called?

A

Ultra-filtration

43
Q

Indications for stopping RRT?

A
  • Return of urine production
  • Return of normal renal function
  • Normalized electrolyte concentration

EDIC - Fundamentals of ICU (10 decks)

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