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Renal > AKI > Flashcards

AKI Flashcards

1
Q

Accelerated HT

A

Diastolic Over 120
Medical emergency
Papilloedema, HF, fits, AKI

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2
Q

Extra-renal manifestations

A

Leukonychia (hypoalbuminaemia)

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3
Q

Mb in urine

A

Rhabdomyolysis - nephritic syndrome
Protein breakdwon
Excess exercise, trauma, dehydrated
CK raised

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4
Q

ECG in hyperkalaemia

A 
Tall tented T waves
No/flat P waves
Long ST segment
Sin waves
VT -> VF -> asystole
Can mean rhabdomyolysis
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5
Q

What is AKI?

A

Abrupt reduction in kidney function (less than 48 hours)
Increase in serum creatinine by 26.4
Increase in creatinine by 50%
Reduction in UO

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6
Q

Pre-renal causes of AKI

A

Hypovolaemia (haemorrhage)
Hypotension (shock)
Renal hypoperfusion (NSAID/ACEI/ARB)

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7
Q

What is pre-renal AKI?

A

Reversible volume depletion leading to oliguria and increased creatinine

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8
Q

Normal urine output

A

0.5ml/kg/hour

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9
Q

Oliguria

A

Less than 0.5ml/kg/hour

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10
Q

Effect of AT on efferent arteriole

A

Vasoconstricts = increased GFR

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11
Q

Effect of ACEI/ARB/diuretic/NSAID on efferent arteriole

A

Vasodilates = decreased GFR

Warn patients about sick day rules (diarrhoea/vomiting = stop taking meds)

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12
Q

Untreated pre-renal AKI leads to:

A

Acute tubular necrosis

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13
Q

What is acute tubular necrosis?

A

Commonest form of AKI in hospital

Decreased renal perfusion due to low BP/sepsis/dehydration/rhabdomyolysis/drug toxicity

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14
Q

Treatment of pre-renal AKI

A

Supportive: reverse cause (stop drugs, rehydrate, antibiotics), dialysis
Asses hydration
0.9% NaCl, NOT dextrose

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15
Q

What is renal AKI?

A

Diseases causing inflammation or damage to cells causing AKI

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16
Q

Causes of renal AKI

A

Vascular: vasculitis, renovascular disease
Glomerular: GN
Interstitial nephritis: drugs (NSAIDs, PPIs, antibiotics), infection (TB, sarcoid)
Tubular injury: ischaemia (prolonged hypoperfusion), drugs (gentamicin), contrast, rhabdomyolysis

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17
Q

Symptoms of renal AKI

A

Anorexia, weight loss, fatigue
N+V
Itch
Oedema, SOB (fluid overload)

18
Q

Signs of renal AKI

A

Fluid overload (HT, oedema, pulmonary oedema, effusions)
Uraemia (itch, pericarditis - rub)
Oliguria

19
Q

Sore throat

A

Post-Strep GN

20
Q

Rash, joint pains

A

SLE, vasculitis

21
Q

D+V

22
Q

Haemoptysis

A

Goodpastures

23
Q

Ca low, phosphate high

A

Vit D deficient (CKD)

24
Q

Eosinophilia

A

Interstitial nephritis

25
Q

High CK, dark urine (Mb)

A

Rhabdomyolysis - IVDU

26
Q

Vascular bruit

A

Renal artery stenosis

27
Q

Investigations for renal AKI

A 
U&Es - K, Na, creatinine, urea
FBC and coag screen (anaemia, CKD, MM)
Urinalysis (protein, blood)
US (obstruction)
Immunology (ANA, ANCA, GBM)
Protein electrophoresis and BJP (MM)
28
Q

Urgent indications for renal biopsy

A

Rapidly progressive GN

Positive immunology and AKI

29
Q

Semi-urgent indications for renal biopsy

A

Unexplained AKI

To rule out obstruction, volume depletion and ATN

30
Q

What do you have to ensure before biopsy?

A

Normal clotting
Not on warfarin/aspirin
Normotensive
No hydronephrosis

31
Q

Treatment of renal AKI

A

Good perfusion pressure: fluid resus, inotrope/vasopressor
Underlying cause: antibiotics
Stop nephrotoxics (ACEI/NSAID/diuretic/Gen)
Dialysis if anuric and uraemia

32
Q

Life threatening complications of renal AKI and indications for dialysis

A

Hyperkalaemia (life threatening)
Fluid overload (oliguric/anuric, not responding to diuretics)
Severe metabolic acidosis pH less than 7.15
Uraemia - pericardial rub, over 40

33
Q

What is post-renal AKI?

A

Obstruction of urine flow leading to back pressure (hydronephrosis) and loss of concentrating ability

34
Q

Causes of post-renal AKI

A

Stones, cancers, strictures, extrinsic pressure

35
Q

Treatment of post-renal AKI

A

Relieve obstruction: catheter, nephrostomy

Stent

36
Q

Hyperkalaemia

A

Life threatening complication of AKI

Over 5.5

37
Q

Life threatening hyperkalaemia

38
Q

Treatment of hyperkalaemia

A

Cardiac monitor and IV access
10ml 10% Ca gluconate over 10 mins
Insulin (actrapid 10 units) with 50ml 50% dextrose
Salbutamol neb 2.5mg
Na bicarbonate if acidotic
Ca resonium (NOT in acute setting, prevents GI absorption)

39
Q

Urgent indications for emergency dialysis

A

Hyperkalaemia over 7 or over 6.5 unresponsive to therapy
Severe acidosis pH less than 7.35
Uraemia over 40 and pericardial rub
Fluid retention unresponsive (pulmonary oedema)

40
Q

Risk factors for AKI

A

Age
Diabetes
Comorbidity
CKD

41
Q

Nephrotoxic drugs

A 
ACEI
ARB
NSAID
Contrast (CT)
Gentamicin

Renal (19 decks)

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