AKI NHBR Flashcards
What is the mechanism of bath salt nephropathy?
Hyperuricaemia
Rhabdomyolysis
What FE Urea indicates pre-renal AKI as opposed to ATN?
<35%
What are the sub-types of CRS?
Type 1: ADHF --> AKI Type 2: CCF --> CKD Type 3: AKI --> ADHF Type 4: CKD --> CCF Type 5: Secondary CRS (sepsis)
What is the benefit of pentoxyfylline in patients with alc hepatitis?
May reduce the risk of HRS but not short-term survival
What is terliepressin?
Synthetic vasopressin 1a agonist
What is the definition of IAH?
IAP ≥ 20mmHg or APP ≤ 60 where APP = MAP - IAP
What is seen on the histology of Contrast Associated Nephropathy?
Vacuolisation in the proximal tubules
What did the POISEIDON trial find?
That fluid therapy guided by LV end diastolic pressure reduced the risk for CI-AKI
What are the high risk malignancies for TLS?
Burkitt Lymphoma
ALL
AML
DLBCL with a LDH ≥ 2 ULN
What are the electrolyte abnormalities in TLS?
Hyperkalaemia
Hypocalcaemia
Hyperuricaemia
Hyperphosphataemia
How does TLS cause AKI?
- Uric acid
- causes crystallopathy
- causes ATIN
- causes reduced renal perfusion - Hyperphosphataemia
- associated with Ca Oxalate crystals
What is the MoA for rasburicase?
Converts UA to allantoin, a soluble metabolite that is excreted renal
Reduces UA level but no evidence to show that it genuinely reduces the risk of TLS
In whom is rasburicase CI?
Those with G6PD and catalase deficiencies… leads to haemolytic anaemia and methaemoglobinaemia, respectively.
What are the biopsy findings in a patient with Hantavirus induced AKI?
- TIN and ATN
- Intersitial oedema
- Medullary haemorrhage
What % of women with postpartum aHUS develop ESKD?
70-80%
How many hours of dialysis does the pregnant patient with ESKD require each week?
≥ 20 hours
Keep BUN <50
What is the pathogenesis of fatty liver of pregnancy?
Foetuses lack long-chain 3 hydroxyl coA dehydrogenase so free fatty acids cross the placenta and cause maternal hepatoxicity.
What is the mechanism of Pre-eclampsia?
- VEGF and TGF B1 play an important role in maintaining endothelial health, both in the kidney and in the placenta.
- In PE, there is an excessive amount of fms-like tyrosine kinase 1 (sFLt1) and soluble truncated endoglin (sEng). These bind VEGF and TGF-B1 leading to reduced circulating levels of these factors and endothelial dysregulation.
- This leads to decreased prostacyclin and NO
- There is an increase in procoagulant proteins
- Decreased levels of placental growth factor and adiponectin and an increase in anti-angiogenic factors such as endostatin.
What was the main finding of STARRT AKI?
Standard initiation of dialysis was associated with reduced risk of dialysis dependence and adverse events at 90 days.
No difference in risk of death between the standard and accelerated risk groups.
What is the advantage of pre-filter dilution in C-HD?
Longer circuit life and better UF (less clearance, however)
What is the advantages of post-filter dilution in C-HD?
Improved clearance
What is the theoretical benefit of convective modalities?
Improved clearance of middle molecules but shorter circuit life
What dose of C-HD is recommended by KDIGO?
20-25ml/kg/hr effluent rate
What is the relationship of filtration fraction to blood flow?
Qb inv. prop to FF
Why are lower blood flow rates preferred with citrate regional anticoagulation?
To prevent the risk of systemic citrate toxicity.
When using post filter RF, what should the Qb be?
≥5 times the RF rate
When using pre-filter RF, what should the Qb be?
≥6 times the RF rate
What should the Qb be set to with CVVHD or CVVHDF?
≥2.5 times the dialysate flow
What is suggested by the results of SMART trial?
Balanced crystalloids > NaCl
