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Renal > AKI > Flashcards

AKI Flashcards

1
Q

What is an abrupt (<48hrs) reduction in kidney function defined as?

A

an absolute increase in serum creatinine by >26.4µmol/l

OR increase in creatinine by >50%

OR a reduction in UO (urine output)

Can only be applied following adequate fluid resuscitation & exclusion of obstruction

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2
Q

Increase >26µmol/L or
Increase > 1.5-1.9 x reference Cr

< 0.5 mL/kg/hr for > 6 consecutive hrs

A

KDIGO stage 1

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3
Q

Increase > 2 to 2.9 x reference SCr

< 0.5mL/kg/hr for > 12 hrs

A

KDIGO stage 2

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4
Q

Increase > 3 x reference SCr or increase to > 354
µmol/L or need for RRT

24hrs or 12 hrs for anuria

A

KDIGO stage 3

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5
Q

Drugs which could cause renal hypoperfusion?

A

NSAIDs/COX-2
ACEi/ARBs
Hepatorenal syndrome

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6
Q

Normal urine output?

A

0.5ml/kg/hour

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7
Q

What is oliguria?

A

<0.5ml/kg/hour

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8
Q

Antiotensin II and arteriolar vasoconstriction and ACEi’s

A

ACE inhibitors reduce Angiotensin II. Angiotension II mediates arteriolar vasoconstriction therefore increasing GFR. ACE I therefore can cause a fall in GFR by causing effferent arteriolar vasodilation.

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9
Q

Why can volume depletion/sepsis cause AKI?

A

Volume depletion/sepsis lead to decreased effective intravascular volume

This leads to increased ADH & aldosterone

Salt and water are retained

Then you get OLIGURIA

= AKI!

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10
Q

Untreated pre-renal AKI leads to what?

A

Acute tubular necrosis

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11
Q

What is the commonest form of AKI in hospital?

A

Acute tubular necrosis

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12
Q

Commonest causes of acute tubular necrosis?

A

Sepsis and severe dehydration

-other causes include rhabdomyolosis and drug toxicity

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13
Q

Treatment for pre-renal AKI?

A
  • Access for hydration

- Fluid challenge for hypovolaemia

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14
Q

How would you assess for hydration?

A

Clinical observations (BP, HR, UO)
JVP, capillary refill time, oedema
Pulmonary oedema

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15
Q

What is the fluid challenge for hypovolaemia in AKI?

A

Crystalloid (0.9% NaCl) or Colloid (gelofusin)
DO NOT USE 5% DEXTROSE

Give a bolus of fluid and then reassess and repeat as necessary
If >1000mls IN and no improvement, seek help!!

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16
Q

Cast nephropathy is a typical renal complication found in patients with which condition?

A

Multiple myeloma

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17
Q

Diseases causing inflammation or damage to cells causing AKI?

A

RENAL AKI

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18
Q

Vascular causes of renal AKI?

A

Vasculitis

Renovascular disease

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19
Q

Glomerular causes of renal AKI?

A

Glomerulonephritis

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20
Q

Interstitial nephritis causes of renal AKI?

A

Drugs
Infection (TB)
Systemic (sarcoid)

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21
Q

Tubular injury as cause of renal AKI?

A

Ischaemia—prolonged renal hypoperfusion
Drugs (gentamicin)
Contrast
Rhabdomyolysis

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22
Q

Signs and symptoms of AKI?

A

Non specific symptoms

Anorexia, weight loss, fatigue, lethargy
Nausea & Vomiting
Itch
Fluid overload
Oedema, SOB

Signs
Fluid overload incl HTN, Oedema, Pul oedema, effusions (pleural & pulmonary)
Uraemia incl itch, pericarditis
Oliguria

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23
Q

Cardio complication of renal AKI?

A

Uraemic pericarditis

24
Q

Renal causes of eosinophila?

A

Interstitial nephritis
Infection
Eosinophilic cystitis

25
HUS triad?
Anemia Thrombocytopenia Acute kidney injury
26
Haematoproteinuria suggests what?
Active glomerulonephritis
27
ANA
SLE
28
ANCA
Vasculitis
29
GBM
Goodpastures
30
BJP?
Bence jones protein | -Used to diagnose and monitor mutliple myeloma
31
Initial invesitgations for MM?
Protein electrophoresis and BJP (bence-jones protein) | -Everyone over 50 years
32
What might low platelets suggest?
HUS | TTP
33
What might abnormal clotting suggest?
DIC | Septic
34
What might anaemia suggest?
CKD | Myeloma
35
How would you diagnose a recent streptococal infection? e.g. if looking for cause of glomerulonephritis?
Culture (swab from throat or infected skin) | Serum antistrepsolysin-O titre
36
Culture (swab from throat or infected skin) | Serum antistrepsolysin-O titre
Used to diagnose streptococcal infection
37
Urgent indications for renal biopsy?
Suspected rapidly progressive GN Positive Immunology & AKI
38
Semi-urgent indications for renal biopsy?
Unexplained AKI to gain a diagnosis Rule out obstruction, Volume depletion & ATN
39
Life-threatening complications of AKI?
``` Hyperkalaemia Fluid Overload (Pulmonary oedema) Severe Acidosis (pH < 7.15) Uraemic pericardial effusion Severe Uraemia (Ur >40) ```
40
What is severe acidosis?
pH <7.15
41
What is severe uraemia?
Ur >40
42
What is thrombotic microangiopathy?
Thrombosis in capillaries and arterioles due to endothelial injury
43
What is post renal AKI?
Obstruction of urine flow leading to back pressure (hydronephrosis) and thus loss of concentrating ability
44
Normal ranges of potassium?
3.5-5
45
Hyperkalemia?
>5.5
46
Life threatening hyperkalemia?
>6.5
47
How could you assess hyperkalemia?
ECG | Muscle weakness
48
ECG changes associated with hyperkalemia?
Normal Peaked T waves Flattened P waves, prolonged PR interval, depressed ST segment, peaked T wave Atrial standstill, prolonged QRS duration, further peaking T waves Sine-wave pattern
49
Treatment for hyperkalemia?
Cardiac monitor & IV access Protect myocardium! (10mls 10% calcium gluconate) Move K+ back into the cells - insulin (actrapid 10 units) with 50mls 50% dextrose (30 minutes) - Salbutamole nebs (90minutes) Prevent absorption from GI tract (calcium resonium--> but not in acute setting)
50
Urgent indications for HD?
Hyperkalemia (>7, >6.5 unresponsive to medical therapy) Severe acidosis (pH 40, pericardial rub/effusion
51
Urgent indications for hemodialysis? HAFU
Hyperkalemia Acidosis, severe Fluid overload Urea
52
Consequences of AKI?
Increased hospital stay Higher costs Increased mortality Increased risk of future CKD
53
40 year old male presenting with general malaise & haemoptysis (Urea 28, Creatinine 600, elevated ant-GBM)
Goodpasture's syndrome
54
25 year old IVDA found collapsed at home
Rhabdomyolosis
55
82 year old man admitted with BP 70 30, T 39, pulse 140bpm, K+ 7.0, urea 48, Cr 789, CRP 250, CXR left basal consolidation
Acute tubular necrosis
56
72 year old man presenting with difficulty passing urine and reduced urine output
Obstructive uropathy

Renal (44 decks)

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