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Renal > AKI > Flashcards

AKI Flashcards

1
Q

what is the definition of AKI

A

an abrupt (<48 hrs) reduction in kidney function;

  • an absolute increase in serum creatinine by >26.4 micromol/l
  • or increase in creatinine by >50%
  • or a reduction in urine output

can only be applied following adequate fluid resuscitation and exclusion of obstruction

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2
Q

what are the stages of AKI

A

1- (increase in serum creatinine >26 micrommol/l or increase > 1.5-1.9 x reference Cr. OR urine output <0.5 mL/hg/hr for >6 hrs)

2- increase >2-2.9 x reference SCr OR uo < 0.5 ml/kg/hr for >12 hrs

3- increase >3 x reference SCr or increase to >/= 354 micromol/L OR need for RRT. OR UO < 0.3 m/kg/hr for >24 hrs OR 12 hours anuria

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3
Q

what are the risk factors for AKI

A 
patient:
old age
CKD
diabetes 
cardiac failure 
liver disease
PVD
previous AKI
exposure:
hypotension 
hypovoleamia
sepsis
deteriorating NEWS
recent contrast 
medications (e.g. gentamicin)
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4
Q

what are the types of causes of AKI

A 
pre renal (functional)
renal (structural) 
post renal (obstruction)
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5
Q

what are the pre renal causes of AKI

A

hypovolaemia (haemorrhage, volume depletion (D&V, burns)

hypotension (cardiogenic shock, distributive shock (sepsis, anaphylaxis)

renal hypoperfusion (NSAIDs/ COX-2, ACEi/ARBs, heptorenal syndrome)

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6
Q

what is a pre renal AKI

A

a reversible volume depletion leading to oliguria and increase in creatinine

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7
Q

what is normal urine output and oliguria

A 
normal= 0.5/kg/hr 
oliguria= <0.5 mls/kg/hr
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8
Q

what test is most sensitive for pre renal aki

A

urine output

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9
Q

what is the normal reaction to decreased renal perfusion

A

release of renin- increases angiotensin II- vasoconstricts efferent arteriole to maintain glomerular flow and GFR

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10
Q

how do ACEi affect GFR

A

prevent vasoconstriction of efferent arteriole in response to reduced renal perfusion- reduced GFR

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11
Q

how can an ACEi cause acute renal failure

A

as if decreased renal perfusion ACEi will exacerbate this causing a major fall in GFR

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12
Q

how much of cardiac output do the kidneys receive

A

20%

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13
Q

what does untreated pre renal AKI lead to

A

acute tubular necrosis

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14
Q

what is the commonest form of AKI in hospital

A

acute tubular necrosis

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15
Q

what causes acute tubular necrosis

A

factors leading to decreased renal perfusion

  • sepsis
  • severe dehydration
  • rhabdomyolysis
  • drug toxicity
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16
Q

what is the treatment for pre renal AKI

A

assess for hydration (BP, HR, UO, JVP, cap refil, oedema)

fluid challenge for hypovolaemia
-crystalloid (0.9% NaCl) or colloid (gelofusin)
DO NOT GIVE DEXTROSE
give bolus then reassess
if >1litre and no improvement seek help (inotropes, vasopressors)

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17
Q

why dont you give dextrose (hartmans) in pre renal AKI

A

as has potassium in it and common to get hyperkalaemic in pre renal AKI

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18
Q

what is renal AKI

A

diseases causing inflammation or damage to cells causing AKI
(blood vessels, glomerular disease, interstitial injury, tubular injury)

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19
Q

what are the vascular causes of renal AKI

A

vasculitis, renovascular disease (same as IHD but in kidneys)

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20
Q

what are the glomerular causes of renal AKI

A

glomerulonephritis

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21
Q

what can cause interstitial nephritis causing renal AKI

A

drugs- penicillin, NSAIDs, PPIs
infection (TB)
sarcoidosis

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22
Q

what can cause tubular injury causing renal AKI

A

ischaemia (prolonged renal hypoperfusion)
drugs (e.g. gentamicin)
contrast
rhabdomoyolysis

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23
Q

what are the symptoms of AKI

A 
non specific:
anorexia, weight loss, fatigue, lethargy 
N and V
itch 
fluid overload (oedema, SOB)
24
Q

what are the signs of AKI

A

fluid overload (HPTN, oedema, pul oedema, effusion (pleural and pulmonary)
uraemia (itch, pericarditis)
oliguria

25
Q

clues to renal cause:

sore throat

A

strep infection

26
Q

clues to renal cause:

rash

A

vasculitis

lupus

27
Q

clues to renal cause:

joint pains

A

lupus

vasculitis

28
Q

clues to renal cause:

haemoptysis

A

vasculitis
goodpastures
EGPA
churg strauss

29
Q

what antibody for good pastures

A

anti GBM

30
Q

how can urinalysis differentate AKI causes

A

if its a renal causes there will be blood and protein in the urine

31
Q

what can cause eosinophillia

A

churg strauss

interstitial nephritis

32
Q

what do vascular bruits suggest

A

renal vascular disease

33
Q

what initial investigations for AKI

A

U&Es (marker of renal function, high potassium?)
FBC and coagulation screen (abnormal clotting- DIC, sepsis) (anaemia?)
urinalysis (haematoproteinuria)
USS- obstruction? size of kidneys- small then CKD, if one small might have renal vascular disease
immunology (ANA- lupus, ANCA- vasculitis, GBM- good pastures)
protein electrophoresis and BJP (myeloma)

34
Q

what are the possible complications of AKI

A 
hyperkalaemia 
fluid overload (pulmonary oedema)
severe Acidosis (pH <7.15)
uraemic pericardial effusion 
severe uraemia (Ur>40)
35
Q

what can cause a post renal AKI

A

= obstruction of urine flow causing back pressure (hydronephrosis) and loss of concentrating ability

  • stones
  • cancers
  • strictures
  • extrinsic pressure
36
Q

what is the treatment for renal AKI

A

fluid resus
treat underlying cause
stop nephrotoxics
dialysis if remains anuric and anaemic

37
Q

what is the treatment of post renal AKI

A

relieve obstruction- catheter, nephrostomy

may need ureteric stenting

38
Q

what is associated with hyperkalaemia

A

cardiac arrhythmias

39
Q

what are the hyperkalaemia parameters

A

normal = 3.5-5
hyper = >5.5
life threatening= >6.7

40
Q

what are the signs of hyperkalaemia

A

ECG- VT, VF, bradycardia, sine wave

muscle weakness

41
Q

what ECG changes are seen in hyperkalaemia

A 
peaked T waves 
flattened P wabes 
prolonges PR interval 
depressed ST segment 
prolonged (broad) QRS 
sine wave

VT, VF, bradycardia

42
Q

what is the treatment for hyperkalaemia

A

10 mls 10% calcium gluconate (protects and stabilises the myocardium)
cardiac monitor
to move K back into cells:
insulin (actrarapid 10 units) with 50 mls 50% dextrose (30mins)
salbutamol nebs (90mins)

prevent GI absorption:
calcium resonium (not in acute setting)

if they are acidotic then give sodium bicarb as acidosis can exacerbate hyperkalaemia

43
Q

what are the urgent indications for haemodialysis

A

hyperkalaemia (>7/ >6.5 unresponsive to therapy)
severe acidosis (pH <7.15)
fluid overload
urea >40, pericardial rub/ effusion

44
Q

what is the mortality of AKI

A

AKI alone 10-30%
AKI with one other organ dysfunction 30-50%
AKI as part of multiorgan failure 70-90%

45
Q

what is the prognosis for AKI

A

10-15% no recovery of renal function
5-10% recover but have progressive CKD
Rest recover

46
Q

what are the sick days rule to prevent AKI

A

if ill with D/V or fever, shakes and sweats then stop taking:

  • ACEi
  • NSAIDs
  • duiretics
  • metformin
47
Q

1.40 year old male presenting with general malaise & haemoptysis (Urea 28, Creatinine 600, elevated ant-GBM)

A

AKI due to good pastures (renal AKI)

48
Q

25 year old IVDA found collapsed at home

A

rhabdomyolosis

49
Q

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

A

acute tubular necrosis due to untreated sepsis (pre renal AKI)

50
Q

72 year old man presenting with difficulty passing urine and reduced urine output

A

obstructive uropathy

51
Q

name 4 drugs that cause hyperkalaemia

A

Spirolonolactone
Ramipril
Amiloride (potassium sparing diuretic)
Atenolol

52
Q

does furosemide cause hyperkalaemia

A

no can cause hyPOkalaemia

53
Q

80 year old male admitted with 4-5 day history of diarrhoea. On admission BP 80 40, pulse 30bpm. Bloods phone back: Na 135, K+ 8.0, Urea 50, Cr 1000, Bicarb 9
Which of the following drugs would you administer first?
A. insulin/dextrose
B. Sodium Bicarbonate
C. Salbutamol nebuliser
D. Calcium Resonium
E. Calcium Gluconate

A

calcium gluconate

54
Q

is elevated creatinine >500 an indication for urgent dialysis

A

no

55
Q

which drug should you avoid in a patient with AKI

A

NSAIDs
ACE/ARB
Diuretics
Gentamicin
Contrast
Trimethorpim- causes hypercalamia increases creatinine
Potassium sparing diuretics- hyperkalaemia

Renal (27 decks)

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