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Urology > AKI > Flashcards

AKI Flashcards

1
Q

What is the definition of AKI?

A

Increase in Serum Creatinine
by ≥ 26.5 μmol/l (0.3 mg/dl ) within 48 hours; or
to ≥ 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or
Urine volume <0.5 ml/kg/h for 6 hours

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2
Q

Describe AKI stage I?

A

1.5-1.9 x creatinine baseline
or >26.5 umol/l increase
Or <0.5ml/kg/h urine output for 6-12 hours

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3
Q

Describe AKI stage 2 ?

A

2.0-2.9 x baseline creatinine

or <0.5ml.. urine output for >12 hours

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4
Q

Describe AKI stage 3

A 
3.0x baseline creatinine
Or increase to >354 umol 
Or initiation of RRT 
Or <0.3 ml.. urine for >24 hours 
Or anuria for >12 hours
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5
Q

What are the immediate dangerous causes of AKI?

A

Acidosis
Electrolyte imbalance
Intoxication
Overload

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6
Q

What are the 3 categories of causes of AKI?

A

Pre renal
Renal
Post Renal

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7
Q

What is the commonest cause of pre-renal AKI?

A

Reduction in effective circulation volume

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8
Q

What are some potential causes of pre-renal AKI?

A

Reduce effective circulation volume
- Volume depletion (haemmorhage / dehydration)
- Hypotension / shock (sepsis is major contributor)
- Congestive cardiac failure / Liver failure
Arterial occlusion
Vasomotor
- NSAIDs/ACE inhibitors

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9
Q

What are some renal causes of AKI?

A 
Acute tubular necrosis 
Toxin related 
Acute interstitial nephritis
Acute glomerulonephritis 
Myeloma 
Intra renal vascular obstruction
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10
Q

What are some post renal causes of AKI?

A

Obstruction

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11
Q

What can cause intraluminal obstruction

A

Calculus

clot

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12
Q

What can cause intramural obstruction?

A

Malignancy
Ureteric stricture
Radiation fibrosis
Prostate disease

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13
Q

What can cause extra mural disease?

A

Retroperitoneal fibrosis

Malignancy

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14
Q

What is radiocontrast nephropathy?

A

AKI following administration of iodinated contrast agent

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15
Q

What is the prognosis for radiocontrast nephropathy?

A

Usually transient renal dysfunction Resolving after 72hrs

May lead to permanent loss of function

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16
Q

What are the risk factors for radiocontrast nephropathy?

A 
DM 
Renovascular disease
Impaired renal function 
Paraprotein 
High volume of radiocontrast
17
Q

What direct history questions are relevant for AKI?

A

FH
Drug exposure
PMH

18
Q

What examinations/signs are relevant for AKI?

A

Flid status
Vital signs (BP, pulse)
Systemic illness

19
Q

What investigations should be done for AKI?

A 
Urine dipstick 
Bloods 
FBC 
Blood gas
USS
20
Q

Which blood tests should be requested for AKI?

A 
U&amp;E
Bicarbonate
Clotting 
FBC 
ANCA
IG immunoglobulins 
C3 complement
21
Q

Which urine tests should be carried out?

A

Blood

Protein

22
Q

What histological investigations should be carried out for AKI?

A

Renal biopsy

23
Q

What are risk events for AKI?

A 
Sepsis
Toxins 
Hypotension 
Hypovolaemia 
Major surgery
24
Q

What things can cause hypovolaemia?

A

Haemorrhage
Vomiting
Diarrhoea

25
Q

What are risk factors for AKI?

A 
>75
Previous AKI 
HF
Liver disease
Chronic kidney disease
Vascular disease
26
Q

Which toxins can cause AKI?

A

X-ray contrast
NSAID’s
Gentamicin

27
Q

Which antibiotic is contraindicated in renal problems?

A

Gentamicin

28
Q

Which measures can be taken to supportively manage fluid balance in AKI?

A 
Volume resuscitation if vol depleted
Fluid restriction if vol. overload 
Optimise BP 
Give fluid/vasopressers 
Stop ACE inhibitors
29
Q

What is the management for toxin related AKI?

A

Stop nephrotoxic drug
Do not give IV radiocontrast unless needed
Use antidote if available

30
Q

What step should be taken if patient hypotensive in AKI?

A

Stop anti-hypertensives drugs

31
Q

What ECG changes are seen in hyperkalaemia?

A

Peaked T waves
P wave widened and flatened
PR segment lengthened

32
Q

What can hyperkalaemia cause?

A

VF/asystole
Cardiac arrests
Death

33
Q

When do you give dialysis in AKI?

A

Low carbonate
High potassium
Pulmonary oedema
Pericarditis

34
Q

Where is haemodialysis given?

A

kidney unite

Urology (13 decks)

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