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TCD Cases > AKI > Flashcards

AKI Flashcards

1
Q

Outline the serum creatine criteria for the staging of AKI according to KDIGO

A

Stage 1 - 1.5-1.9 times base line or >26micromol/L increase

Stage 2 - 2-2.9 times baseline

Stage 3 - Increase of 3 times baseline or increase in serum creatine >354micromols/L or initiation of RRT

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2
Q

Outline the urine output criteria for the staging of AKI according to KDIGO

A

Stage 1 - <0.5ml/kg/hr for 6-12 hours

Stage 2 - < 0.5mls/kg/ht for over 12 hours

Stage 3 - <0.3mls/kg/hr for over 24 hours or anuria for over 12 hours

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3
Q

Recall the components of the mnemonic SALFORD for the management of patients with AKI

A

S -Sepsis and other causes –> treat
A - ACE/ARBS and NSAIDS, suspend or review prescriptions
L - Labs (and leaflets for patient education)
F - Fluid assessment and response
O - Obstruction
R - Renal/ critical care referral
D - Dip the urine and record it

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4
Q

What are the 4 main causes of fluid overload?

A
  1. Iatrogenic
  2. Cardiac failure
  3. Renal failure
  4. Increased ADH secretion
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5
Q

Define Acute Kidney Injury

A

A clinical syndrome characterised by a rapid reduction in renal excretory function which can be due to a variety of causes.

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6
Q

Suggest 7 potential causes of pre-renal AKI

A
  1. Dehydration
  2. Shock
  3. Sepsis
  4. Hypotension
  5. Hepatorenal syndrome
  6. Severe heart failure
  7. Intra abdominal hypertension/ compartment syndrome
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7
Q

Suggest 9 potential causes of renal AKI

A
  1. NSAIDS
  2. ACEi
  3. ARBS
  4. Gentamicin
  5. GN/ Vasculitis
  6. Contrast
  7. Interstitial nephritis
  8. Myeloma
  9. Rhabdomyolysis
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8
Q

Suggest 3 potential causes of post renal AKI

A

I.e caused by obstruction

  1. Prostate enlargement
  2. Renal stones
  3. Pelvic cancer
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9
Q

How is chronic kidney disease defined

A

eGFR consistently less than 60

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10
Q

Define hydronephrosis

A

Swelling of the kidney due to an abnormal build up of urine due to an obstruction

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11
Q

The presence of both blood and protein in a urine dipstick test may indicate what condition?

A

Glomerulonephritis

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12
Q

Name 4 medical complications of AKI which are considered indicators for dialysis

A
  1. Hyperkalemia
  2. Pulmonary oedema
  3. Metabolic acidosis
  4. Uraemic encephalopathy or uraemic pericarditis
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13
Q

85% of AKI’s are associated with what ateiological subsection

A

Pre-renal

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14
Q

Outline the 3 phases of acute tubular necrosis

A
  1. Oliguric phase
  2. Maintenance phase
  3. Polyuric recovery phase
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15
Q

Define sepsis

A

Life threatening organ dysfunction caused by a dysregulated host response to infection.

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16
Q

What is the initial treatment regime for fluid resuscitation?

A
  1. Identify cause of deficit and respond

2. Fluid bolus of 500mls crystalloid over less than 15 minutes

17
Q

If a patient does not respond to an initial bolus for fluid resuscitation, what total volume of fluid is it appropriate to give before seeking expert advice?

A

Repeat doses of bolus 500mls crystalloid over less than 15 minutes can be given until a maximum volume of 2000mls has been administered.

18
Q

Outline the normal daily fluid and electrolyte requirements needed as part of maintenance fluid

A
  1. 25-30ml/kg/d water
  2. 1 mmol/kg/day sodium, potassium and chloride
  3. 50-100 g/day glucose
19
Q

Outline the general physiological distribution of 42L of total body water throughout the body.

A

Intracellular fluid - 28L

Extracellular fluid - 14L
The extracellular fluid compartment can be further subdivided into:
Interstitial - 9L
Plasma/transcellular - 5L

20
Q

Define the term ‘tonicity’ with reference to fluid shift

A

The relative osmolality between 2 fluid compartments

21
Q

In what subgroup of patients is starch based colloid fluids contra-indicated in?

A

Surgical patients due to the risk of AKI and bleeding

22
Q

Recall the 5 R’s of fluid prescription

A
  1. Resuscitation
  2. Routine maintenance
  3. Replacement
  4. Redistribution
  5. Reassessment
23
Q

What are the 4 circumstances that a patient with an AKI requires discussion with the renal team?

A
  1. All patients with a renal transplant
  2. All patients with an AKI 3
  3. All AKI (stage 1,2 or 3) with protein and blood on urine dipstick
  4. All patients with no known cause of their AKI and with deteriorating renal function
24
Q

Suggest 3 clinical means of removing potassium from the body

A
  1. Loop diuretics
  2. Dialysis
  3. Calcium resonium (orally or via enema)
25
Q

Name 5 medications that must be stopped in patients with AKI as they risk further deterioration of renal function

A
  1. NSAIDS
  2. Aminoglycosides
  3. ACE inhibitors
  4. ARBs
  5. Diuretics
26
Q

A poor response to fluid challenge is most characteristic of what type fo AKI aetiology?

A

Acute tubular necrosis

TCD Cases (25 decks)

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