AKI

Question 1

what happens to urea and Cr during AKI?

Answer 1

both increase

Question 2

what are the post renal causes of renal disease ? SNIPPIN?

Answer 2

Stone
􏰁 Neoplasm
􏰁 Inflammation: stricture
􏰁 Prostatic hypertrophy
􏰁 Posterior urethral valves
􏰁 Infection: TB, schisto
􏰁 Neuro: post-op, neuropathy

Question 3

what is the presentation of AKI?

Answer 3

Uraemia / Azotaemia
􏰀 Acidosis
􏰀 Hyperkalaemia
􏰀 Fluid overload
􏰁 Oedema, inc. pulmonary 􏰁 ↑BP(or↓)
􏰁 S3 gallop
􏰁 ↑ JVP

Question 4

what investigations should be done for AKI?

Answer 4

Bloods: FBC, U+E, LFT, glucose, clotting, Ca, ESR
􏰀 ABG: hypoxia (oedema), acidosis, ↑K+
􏰀 GN screen: if cause unclear
􏰀 Urine: dip, MCS, chemistry (U+E, PCR, osmolality, BJP)
􏰀 ECG: hyperkalaemia
􏰀 CXR: pulmonary oedema
􏰀 Renal US: Renal size, hydronephrosis

Question 5

in pre renal failure, is urine dilute or concentrated?

Answer 5

concentrated

Question 6

is Na conc of urine in pre renal failure high or low?

Answer 6

low <20mM

Question 7

what is ESRF?

Answer 7

complete loss of function >3months

Question 8

what are the 5 stages of AKI?

Answer 8

RIFLE

Question 9

what is the GFR at each stage of AKI?

Answer 9

reduced GFR of 
Risk = 25%
Injury = 50% 
Failure = 75% 
Loss = 100%

Question 10

what is the normal Cr?

Answer 10

125

Question 11

what is the minimum urine output ?

Answer 11

0.5ml/kg/day

Question 12

what are indications of acute dialysis ? AEIOU

Answer 12

hyperkalaemia 
refractory pulmonary oedema 
symptomatic uraemia 
severe metabolic acidosis 
poisoning

Question 13

how does urea affect bleeding?

Answer 13

impairs haemostasis so increases risk of bleeding

Question 14

what can be used to treat bleeding during AKI?

Answer 14

FFP and platelets