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Renal > AKI > Flashcards

AKI Flashcards

1
Q

how is AKI defined v CKD

A

AKI- change in serum creatinine over days, CKD- change in eGFR over months

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2
Q

what is AKI defined as (KDIGO) guidelines

A

increase in serum creatinine by over 50% from baseline or urine output 26umol/l in 48 hours.

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3
Q

what is stage 1 AKI (KDIGO)

A

incr creatinine 1.5x baseline. urine 6 consec hours

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4
Q

what is stage 2 AKI (KDIGO)

A

increase 2-2.9 x baseline. urine 12 hours

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5
Q

what is stage 3 AKI (KDIGO)

A

increase >3 x baseline. urine 24hour or anuria for 12hour

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6
Q

what are the risk factors for developing AKI

A

age >75, CKD, cardiac failure, peripheral vascular disease, chronic liver disease, diabetes, sepsis, drugs, poor fluid intake/increased losses, history of urinary symptoms

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7
Q

what are the commonest causes AKI

A

ischaemia, nephrotoxins and sepsis

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8
Q

what are the causes split into and % of AKI

A

pre renal (40-70%), intrinsic renal (10-50%), post renal (10-25%)

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9
Q

what are the pre renal causes due to

A

renal hypoperfusion- hypotension (hypovolaemia, sepsis), renal artery stenosis +- ACEi

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10
Q

what are the intrinsic renal causes due to

A

tubular- acute tubular necrosis (commonest), crystal damage, myeloma. glomerular- autoimmune SLE, HSP, drugs, infections. Interstitial- drugs, infiltration. vascular- vasculitis, malignant BP, thrombus chol emboli, HUS/TTP

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11
Q

what are the post renal causes due to

A

luminal- stones, clots; mural- malignancy, BPH, strictures. extrinsic compression- malignancy, retroperitoneal fibrosis

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12
Q

what can be found on examination

A

palpable bladder, palpable kidneys, abdominal/pelvic masses, renal bruits, rashes

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13
Q

blood tests

A

U&E, FBC, LFT, clotting, CK, ESR, CRP. ABG? cultures if signs infection.

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14
Q

what auto antibodies can be tested

A

ANCA, ANA, anti-GBM)

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15
Q

what imaging can be used

A

renal USS- distinguish obstruction and hydronephrosis

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16
Q

is complete anuria common or rare

A

rare- in AKI suggests obstructive cause

17
Q

what shows that it is chronic kidney

A

small kidneys- <9cm on USS, anaemia, low Ca2+, high PO43-, only definite sign is high creatinine/low eGFR

18
Q

what are the indications for dialysis

A

pulmonary oedema, persistent hyperkalaemia, severe metabolic acidosis, encephalopathy, uraemic pericarditis, drug overdose

19
Q

what are the general measures in management

A

assess vol status, aim for euvolaemia, stop nephrotoxic drugs, monitoring, nutrition

20
Q

what do incr bp, incr jvp, lung creps, peripheral oesema, gallop rhythm on auscultation indicate

A

fluid overload

21
Q

what drugs are nephrotoxic

A

NSAIDs, ACEi, gentamicin, amphotericin

22
Q

when do you need to stop metformin

A

if creatinine >150mmol/L

23
Q

treat underlying cause- pre renal

A

correct volume depletion- fluids, treat sepsis- antibiotics

24
Q

treat underlying cause- post renal

A

catheterise, CT of renal tract, cystoscopy or retrograde stents

25
Q

what are the complications

A

hyperkalaemia, pulm oedema, uraemia, acidaemia

26
Q

what complications can arise from uraemia

A

encephalopathy, pericarditis

27
Q

what options are there in renal replacement therapy

A

haemodialysis and haemofiltration

28
Q

what are the ECG changes for hyperkalaemia

A

tall T waves, small or absent p wave, incr PR interval, widened QRS, asystole

29
Q

how to treat hyperkalaemia

A

10mL 10% calcium gluconate over 2 min (cardioprotective); IV insulin and glucose; salbutamol nebs (high doses); IV sodium bicarb

30
Q

how does insulin work to treat hyperkalaemia

A

insulin stimulates intracellular uptake of K+. salbutamol has a similar effect as insulin/glucose

31
Q

how to treat pulmonary oedema

A

sit up give high flow O2. venous vasodilator eg diamorphine 2.5mg IV. furosemide 80-250mg. haemodialysis or haemofiltration. CPAP. IV nitrates

32
Q

how to prevent AKI

A

review drugs- withhold/avoid: diuretics, ACEi, anti hypertensives if bp low, NSAIDs, nephrotoxic antibiotics. use opiates with caution. so contrast CT scans and procedures. ensure pt well hydrates- 1L 0.9% saline over 12 hours.

Renal (10 decks)

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