AKI

Question 1

pre renal causes of AKI

NB THESE ARE THE MOST COMMON CAUSES

Answer 1

think causes of hypoperfusion/hypotension/slower filtration

• dehydration
• D+V
• haemorrhage
• oedematous states (HF, cirrhosis, nephrotic syndrome)
• sepsis
• cardiogenic shock
• drugs: NSAIDs, ACEis,
• renal artery stenosis

Question 2

renal causes of AKI

Answer 2

• Glomerular disease
• Acute tubular necrosis
• Nephrotoxins (e.g. contrast
• Acute interstitial nephritis (NSAIDs, infection)
• Vasculitis
• Malignant HTN
• Eclampsia

Question 3

post renal causes of AKI

Answer 3

OBSTRUCTION

urethral stricture, BPH/pmalig, bladder malig, pelvic malig

Question 4

px AKI

Answer 4

rise in serum creat
oliguria
N+V
dehydration
confusion

Question 5

define oliguria

Answer 5

<0.5ml/kg/hr over six hrs

Question 6

AKI defined as

Answer 6

Cr >=26.5 above baseline in 48h
Cr increased by 50% in preceding 7 days
-oliguric
THIS IS STAGE 1

Question 7

what should you do if they are <0.5ml/kg/hr over 4 hours

Answer 7

still intervene as they are heading to AKI!! The point of this question is to show that you should shouldn’t wait till they have AKI before you treat

Question 8

stats of AKI

Answer 8

10-20% of hospital admissions

30-60% ITU admissions

Question 9

high risk of AKI

Answer 9

CKD
diabetes
diffuse atherosclerosis
HF
multiple myeloma
elderly

NB risks factor + insult = v v high risk of aki!!

Question 10

what cancer can often cause AKI

Answer 10

multiple myeloma - remember the case on minerva!

Question 11

how to protect kidneys before radioactive contrast scan

Answer 11

stop risky meds

ensure still hydrate (possibly give fluids)

Question 12

rx AKI

Answer 12

• ABCDE!!! (common problem in F1)
• urgently treat hyperkal
• treat cause
• monitor fluid and electrolyte balance
• fluid therapy (avoid overload by measuring UO)
• stop nephrotoxic drugs
• RRT if not responding to rx

Question 13

what electrolytes ot monirot in AKI

Answer 13

creatinine
na
k
ca
phos
gluc!!!

Question 14

ix AKI

Answer 14

• urinalysis
• creat to assess renal function (cannot use egfr)
• U+Es. need ecg if K+ raised
• USS
• soluble immunology - to find cause if looks possible
• kidney biopsy

Question 15

soluble immunology

Answer 15

complement
Ig electrophoresis
ANCA, anti GBM, glupus serology

Question 16

what is rapidly progressing glomerulonephritis

Answer 16

nephritis + rapidly worsening renal function. not a diagnosis.
can be cuased by vascultiis, antiGBM disease, SLE, HSP

Question 17

should fluid be given in AKI

Answer 17

you may think no because their kidneys aren’t working and therefore it would cause them to be fluid overloaded…BUT often kidney failure is caused by hypovolaemia so fluid will actually get the kidneys back working
you just need to be careful to monitor the urine output to check they aren’t retaining it all….especially in heart failure pts.

Question 18

should furosemide be given in AKI

Answer 18

if overloaded, may need to increase dose
if dehydrates, need to stop dose.
therefore, you need to clinically assess everyone r AKI and furosemide

Question 19

what are the DAMN drugs

Answer 19

diuretics, ACEi, metformin, NSAIDs

drugs that cause AKI

Question 20

stages of AKI

Answer 20

1 cr 1.5x baseline, <0.5ml/kg >6hr
2 cr 2x baseline, <0.5ml/kg >12 hr
3 cr 3x baseline <0.3ml/kg >24 hr OR anuria >12 hr or RRT

Question 21

what happens to the kidneys in sepsis/shock

Answer 21

poor flow causes AKI but also poor flow leads to poor perfusion of all kidney cells causing ACUTE TUBULAR NECROSIS

Question 22

what do NSAIDs cause in kidney

Answer 22

acute interstitial nephritis

Question 23

what can cause tubular toxicity

Answer 23

CONTRAST
GENTAMICIN (this is the reason you are constantly checking gent levels)