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AKI Flashcards

1
Q

What is AKI?

A

A ‘syndrome’ arising from a rapidly falling eGFR

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2
Q

What is eGFR?

A

Estimated glomerular filtration rate

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3
Q

How is eGFR measured?

A

It is estimated using serum creatinine, alongside the patients age/sex/race

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4
Q

What are normal eGFR values?

A

Normal eGFR >90ml/min

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5
Q

What measurements and values constitute an AKI?

A

Serum creatinine >26.5 micromoles/L in <48hrs

OR

…a rise >1.5-fold from baseline in the preceding (before) 7 days

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6
Q

What are normal serum creatinine levels?

A

70-110 micromol/L

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7
Q

What nitrogenous things are retained in AKI?

A

Urea

Creatinine

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8
Q

What is a stage 1 AKI?

A

Serum creatinine rise >26.5 micromol/L in <48hrs

OR

…a rise in serum creatinine 1.5-1.9 fold from baseline

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9
Q

What is a stage 2 AKI?

A

A serum creatinine rise of 2.0-2.9 fold from the baseline

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10
Q

What is a stage 3 AKI?

A

Serum creatinine rise >3.0 fold from baseline

OR

…serum creatinine rises to >353.6 micromol/L

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11
Q

What are the 3 classifications of AKI?

Roughly what does each mean?

A

1) Pre-renal (volume depletion)
2) Intrinsic renal (kidney problem)
3) Post-renal (drainage issues)

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12
Q

What is cast nephropathy?

What type of AKI does this cause?

What other signs do myeloma sufferers have?

A

Myeloma cast nephropathy is when free Ig light chains (as the Ig’s do not form properly) form plugs in the renal tubules

It causes a intrinsic renal AKI

They also have hypercalcaemia (and bone pain) due to bone breakdown

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13
Q

Name some drugs which cause acute tubular necrosis and therefore intrinsic renal AKI’s.

A

(remember AAARI)

  • amphotericin (anti-fungal)
  • antibiotics (aminoglycosides) such as gent/streptomycin
  • anti-retrovirals
  • acetaminophen (paracetamol)
  • radiocontrast
  • IV Ig
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14
Q

Name 4 hormones or groups of hormones the kidneys synthesise.

A
  • Erythropoeitin
  • Renin
  • Vit D
  • Prostaglandins
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15
Q

Name 4 receptors found in the kidneys.

A
  • ANP = vasodilates afferent areteriole, increasing GFR and sodium and water excretion
  • ADH (vasopressin) = water reabsorption
  • PTH = upregulates Vit D synthesis
  • Aldosterone = sodium and water reabsorption and potassium excretion
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16
Q

What is a normal potassium level?

A

3.5 - 5.0mmol/L

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17
Q

What ECG response is seen in potassium levels 5.5-6.5mmol/L?

A

Tall tented ‘T’ waves

Prolonged PR segment

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18
Q

What ECG response is seen in potassium levels 6.5-8.0mmol/L?

A

Loss of P waves
Prolonged QRS complex
ST elevation
Ectopic beats

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19
Q

What ECG response is seen in potassium levels >8.0mmol/L?

A

Even wider QRS complexes
Sine wave ‘esque’ shape
Sever arrhythmias!!

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20
Q

What does an AKI show up as on a blood gas?

A

Metabolic acidosis

May have compensatory respiratory alkalosis

21
Q

What is the retention of of urea and other nitrogenous waste compounds (as seen with AKI) in the blood called?

22
Q

What cardiac problem may arise with uraemia (as seen in AKI)?

A

Uraemic pericarditis

23
Q

What lung problem may arise with uraemia (as seen in AKI)?

A

Pleurisy (inflammation of the pleura)

24
Q

What neurological problem may arise with uraemia (as seen in AKI)?

A

Encephalopathy (neurological disorder)

25
Q

What is RRT and what does it stand for?

When is it indicated?

A

Renal replacement therapy = dialysis

Indicated in life threatening AKI complications (e.g. any of the uraemic complications)

26
Q

What is the waste that comes from dialysis called?

27
Q

Explain Tumour lysis syndrome and when it occurs?

How does this cause AKI?

A

It occurs from the lysis of cancer cells following treatment

As they release their content into the bloodstream, potassium and phosphate levels rise, whilst calcium drops

The hyperphosphatemia deposits calcium phosphate crystals in the parenchyma therefore causing kidney failure and AKI

This mainly occurs after lymphomas and leukemias

28
Q

What is the name of the scoring system used to determine delirium?

What score gets you ‘delirium’?

29
Q

What are rod shaped bacteria called?

30
Q

What are spherical shaped bacteria called?

31
Q

What shape and gram bacteria may suggest UTI?

A

-ve rod shape

32
Q

What colour do gram +ve bacteria stain?

33
Q

What colour do gram -ve bacteria stain?

34
Q

What are the most common bacteria that cause UTI?

A 
1 = E. coli
2 = Klebsiella 
3 = Proteus spp.
35
Q

How do you determine between AKI and CKD if a baseline is not known (e.g. someone comes in and their first creatinine is high)?

A

ALWAYS treat as AKI until proven otherwise!

36
Q

What is urea the product of?

When may urea levels rise?

A

High protein intake

Dehydration, GI bleed (as ingesting RBC’s = high protein)

37
Q

What is a normal arterial blood gas PO2?

38
Q

What is a normal arterial blood gas HCO3?

A

22-26mEq/L

39
Q

What happens to kidneys on ultrasound in CKD?

A

They have atrophied

40
Q

What is a side effect of ramipril?

Why is this?

A

Dry cough

ACE usually causes bradykinin to breakdown into metabolites

Ramipril inhibits ACE, therefore bradykinin builds up and causes a dry cough via bronchoconstriction

41
Q

How does acidosis cause hyperkalaemia?

A

Hydrogen ions causing acidosis intracellularly displace K ions which leave cells and travel to the extracellular compartment

42
Q

What classes of drugs should be stopped in the event of an AKI?

A
  • NSAIDS (inhibit afferent arteriole vasodilation)
  • ACE inhibitors (ramipril) (vasodilate efferent arteriole, reduce BP)
  • ARB (angiotensin receptor blockers = candesartan) (work the same as ACE inhibitors)
  • Diuretics (eventually cause hypovolaemia which reduces GFR)
  • Other BP lowering drugs…
  • Drugs which accumulate with reduced kidney function (Metformin, glyclazide, trimethoprim)
  • Drugs which may be the cause of the AKI!
43
Q

How would hydronephrosis appear on an ultrasound kidney?

A

The centre of the kidney is usually white and whispy, but instead if the renal pelvis is filled with fluid and dilated the centre of the kidney will appear dark black and distended

44
Q

What is the first step in treating hyperkalaemia?

A

Reduce cardiac excitability by giving calcium

This has no effect on the actual K+ levels, but purely protects the heart from arrhythmias

45
Q

What is the second step in treating hyperkalaemia?

A

Shift the extracellular K+ intracellularly by giving insulin/glucose

46
Q

What is the third step in treating hyperkalaemia?

A

Reduce total body K+ levels with loop diuretics

Do NOT give haartmans as contains K+

47
Q

What is ANCA and what does it mean if someone is ANCA +ve or -ve?

A

ANCA = anti- neutrophil cytoplasm antibodies = autoantibodies to neutrophil cytoplasm proteins

ANCA +ve = helps detect certain autoimmune conditions such as…

1) granulomatosis with polyangititis (Wegener’s)
2) eosinophilic granulomatosis with polyangiitis (EGPA) (Churg-Strauss)

48
Q

What do WG and EGPA both cause?

A

Vasculitis of the small vessels

Supporting Life (12 decks)

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