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RENAL QS > AKI > Flashcards

AKI Flashcards

1
Q

What is the definition of an AKI?

A

Rise in Cr 26+ micromol/L in 48h

OR

50% or more rise in Cr over 7d

OR

Fall in urine output to <0.5ml/kg/h for >6h in adults

OR

25% or more fall in eGFR in 7d

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2
Q

What are the three categories of causes and which is most common?

A

Pre-renal - most common
Renal
Post-renal - least common

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3
Q

What is the pathophysiology of pre-renal causes?

A

Decrease in kidney perfusion

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4
Q

What are the pre-renal causes?

Which is most common?

A

Vol depletion - diarrhoea, blood loss, dehydration (MOST COMMON)

Decreased CO - MI, HF

Sepsis

Drugs e.g. ACEi, NSAIDs
- reduce BP and renal blood flow

Renal A stenosis

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5
Q

Which two drugs should you SHOULDN’T give together?

A

ACEi and NSAIDs

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6
Q

What is the pathophysiology of renal causes?

A

Direct damage to kidney

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7
Q

What are the renal causes of AKI?

A

Vascular - vasculitis, malignant HTN

Tubular - acute tubular necrosis**, rhabdomyolysis, myeloma, radiocontrast (common), drugs e.g. abx

GN

Interstitial nephritis

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8
Q

How does myeloma cause AKI?

A

Light chains are toxic to tubules

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9
Q

What is the pathophysiology of post-renal causes and what are they?

A

Obstruction of urinary flow

Causes:

  • Tumours
  • Stones
  • Strictures
  • Blood clots
  • BPH
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10
Q

Name 4 RF

A 
Elderly >65y
CKD
Chronic conditions - DM, HF (toxic drugs), liver disease
Neurological/cognitive impairement
Cancer - myeloma/drugs
Previous AKI
Post-op - sepsis, hypovolaemia 
Meds - NSAIDs, contrasts
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11
Q

What are the SX?

A

Depends on the cause

Reduced urine output

Vomiting

  • Early - cause
  • Late - uraemia

Dizziness (pre-renal = orthostatic)

Orthopnoea - fluid overload

HTN
HypoTN

Uraemia - altered mental state, pericarditis, pruritus/bruising, fatigue/nausea

Pulmonary/ peripheral oedema

Arrhythmia - hyperK and acid-balance changes

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12
Q

What IX need to be undertaken?

A

U&E + Cr

  • high Cr
  • hyperK - metabolic acidosis

Urine dip, MCS

  • UTI - leucocytes/nitrites
  • GN - blood/protein

FBC

  • anaemia (CKD/blood loss)
  • leucocytosis
  • thrombocytopenia (HUS, TTP)

ECG - hyperK

Renal USS - done within 24h if no identifiable cause

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13
Q

Name 5 nephrotoxic drugs

A

CANT DAMAG

Contrast 
Abx - penicillin, rifampicin 
NSAIDs
Therapeutic Index (narrow) - ?lithium
Diuretics 
ACEi
Metformin 
ARB
Gentamicin/Gold
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14
Q

What is creatinine?

What is it used to IX kidney function?

A

Waste product of normal muscle metabolism

It is a long-standing measure of kidney function because it is purely excreted by kidneys

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15
Q

What factors can creatinine be affected by?

A

Muscle mass - higher in those with higher muscle mass

Ethnicity

Gender - higher in males

Age - increase with age

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16
Q

Can a pt still have an AKI with a Cr in reference range?

What else can indicate AKI other than Cr?

A

Yes

Change in urine output may be the first to change

17
Q

What is KDIGO?

A

AKI staging

Look at table in renal lec notes

18
Q

What is the MX?

A

Stop nephrotoxic drugs

Supportive - careful fluid balance to maintain perfusion of kidneys but avoid fluid overload

RX CAUSE!!!

  • Pre-renal: Fluid, stop drugs, RX underlying cause
  • Renal: Biopsy/referral
  • Post-renal: clear obstruction, catheterise, CT renal tract

HyperK:

  • IV Ca gluconate to stabilise
  • Combined insulin/dextrose infusion + neb salbutamol for cellular shift
  • Calcium resonium, loop diuretics, dialysis to remove K from body

Renal Replacement Therapy
(Haemodialysis)
- used if pts not responding to medical RX of complications e.g. hyperK, severe acidosis (HCO3 <15) or uraemia

Refer

19
Q

When do you refer to renal?

A
  • Persistent oliguria
  • Serum Cr >350 umol/L
  • Indication for dialysis – hyperkalaemia, severe acidosis (HCO3 <15), pulmonary oedema
  • Need for iodinated contrast
  • Blood and protein in urine
  • No clear cause for AKI
20
Q

Which drugs need to be stopped?

A 
NSAIDs
Aminoglycosides - gentamicin
ACEi
ARBs
Diuretics 
Metformin
Lithium 
Digoxin
21
Q

Which drugs are safe to continue in an AKI?

A 
Paracetamol 
Warfarin 
Statins
Aspirin (at 75mg OD)
Clopidogrel
BBs
22
Q

What are the causes of intrinsic renal failure?

INTRINSIC

A 
Ischaemia
Nephrotoxic Abx (gentamicin, vancomycin)
Tablets (ACEi, NSAIDs)
Radiological contrast
Injury (rhabdomyolysis)
Negatively bifringent crystal (gout)
Syndromes (GN)
Inflammation (vasculitis)
Cholesterol emboli

RENAL QS (12 decks)

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