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Nephrology > AKI > Flashcards

AKI Flashcards

1
Q

Define AKI?

A

Rapid reduction in kidney function

Over hours - days

As measured by serum, urea and creatinine

Leading to a failure to maintain fluid, electrolyte and acid-base homeostasis

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2
Q

What is the KDIGO criteria of AKI?

A

Rise in serum creatinine of 26+ micromol/L in 48 hours

A 50% or greater rise in serum creatinine in preceding 7 days

UO < 0.5ml/kg/hr for 6 hours (or 8 in children)

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3
Q

What 3 components are used to stage AKI?

A

Creatinine
GFR
Urine output

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4
Q

Describe AKI staging?

A

RIFLE
Stage 1, 2, 3

  1. risk
    - raised creatinine x 1.5
    - <0.5ml/kg/hr UO in 6h
  2. injury
    - raised creatinine x 2
    - <0.5ml/kg/hr UO in 12h
  3. failure
    - raised creatinine x 3
    - <0.3ml/kg/hr UO in 24hrs OR anuria for 12h
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5
Q

What is creatinine?

A

Breakdown product of creatine kinase or creatine phosphate which is in muscles

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6
Q

3 categories of causes of AKI?

A

Pre-renal

Intrinsic renal

Post-renal

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7
Q

What are the pre-renal causes of AKI?

A

Hypotension: volume depletion (haemorrhage, severe D+V, burns) sepsis, cardiogenic shock

Oedema: cardiac failure, cirrhosis, nephrotic syndrome

Renal hypoperfusion: drugs, AAA, renal artery stenosis/occlusion

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8
Q

Which drugs can cause AKI? And how?

A

ACE inhibitors
ARBs

NSAIDs
COX2 inhibitors

Diuretics

Gentamicin
Contrast for CT scans

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9
Q

What are the intrinsic renal causes of AKI?

A

Glomerular disease

  • glomerulonephritis
  • thrombosis
  • haemolytic uraemic syndrome

Tubular injury

  • acute tubular necrosis after ischaemia
  • nephrotoxins

Acute interstitial nephritis

  • drugs (NSAIDs)
  • infection
  • autoimmune

Vascular:

  • vasculitis
  • renal artery stenosis
  • renal vein thrombosis

Eclampsia
Multiple myeloma

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10
Q

What are the post-renal causes of AKI?

A

SNIPPIN

Stone
Neoplasm
Inflammation
Prostate
Posterior urethral valves
Infection
Neuropathic bladder
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11
Q

Risk factors for AKI?

A

Age over 65
CKD
History of AKI
Co-morbidities

Reliance on carer for access to fluids (eldery, children, disabled)

Sepsis

Urological obstruction

Drugs: ACEi, ARBs, NSAIDs, diuretics

Peri-operative period

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12
Q

Investigations of suspected AKI?

A

Assess volume status

Urgent K+
ECG

Urinalysis + MC+S
- Bence jones protein

Blood tests: FBC, U+E, LFTs, creatinine, coag, CK, CRP, ESR

Where appropriate USS, AXR, MRI

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13
Q

How can you assess patient’s volume status?

A 
BP
Pulse
Skin turgor
Mucous membranes
CRT
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14
Q

Presentation of AKI?

A

Azotaemia, uraemia

Oliguria or anuria

Hyperkalaemia

Fluid overload (oedema, hyper/hypotension, raised JVP)

N+V
Dehydration
Confusion

Plus symptoms relating to the cause of the AKI

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15
Q

What are the symptoms of uraemia?

A 
Nausea
Vomiting
Fatigue
Anorexia
Weight loss
Muscle cramps
Pruritus
Confusion
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16
Q

Management of AKI?

A

Pre-renal: correct the volume depletion, treat cause

Intrinsic renal: refer nephrology

Post-renal: catheterise, treat cause

Supportive

  • fluid balance (i.e don’t overload)
  • stop nephrotoxic drugs
  • monitor electrolytes, creatinine closely
  • nutritional intake
17
Q

What are the complications of AKI?

A

Hyperkalaemia

Acidosis

Pulmonary oedema

Bleeding

18
Q

Features of hyperkalaemia on ECG?

A

Peaked T waves
Flattened P waves
Increased PR
Wide QRS

Sine wave pattern leading to VF

19
Q

What are the signs of fluid overload?

A

Oedema (pulmonary, peripheral)

Raised JVP

Hyper/hypotension

S3 gallop

20
Q

Why does AKI cause acidosis?

A

Metabolic products that are acidic aren’t being excreted

Uraemia

21
Q

Why does AKI cause bleeding?

A

Raised urea causes impaired haemostasis

22
Q

How do you manage hyperkalaemia?

A

Calcium gluconate

Glucose and insulin (because insulin draws glucose into cells, which takes K with it)

Salbutamol nebulisers (works same as glucose and insulin)

23
Q

How do you manage pulmonary oedema?

A

High flow oxygen
Morphine
Furosemide

24
Q

How do you manage uraemia?

A

Fluids
Dialysis may be required
But if not treat the symptoms

25
Q

How do you manage bleeding caused by AKI?

A

Fresh frozen plasma and platelets

Transfuse blood

Nephrology (5 decks)

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