AKI/SEPSIS

Question 1

what is the definition of AKI?

Answer 1

creatinine increase >26umol/L within 48hrs

creatinine increase >1.5 x baseline over 7 days

UO <05.ml/kg/hr for 6 consecutive hours

Question 2

what are the risk factors for AKI?

Answer 2

male
age
pre-existing CKD
DM
CVD
malignancy

Question 3

how is the severity of AKI staged?

Answer 3

KDIGO staging system- staged according to highest creatinine rise or longest / most sustained period of oligouria

Question 4

what are the causes of pre-renal AKI? (6)

Answer 4

sepsis
cardiogenic shock
dehydration
hypotension
CCF
renal artery stenosis (bilateral)

Question 5

what are the causes of renal AKI? (7)

Answer 5

drugs (the 4 A's = Acei, Arb, nsAids, gentAmicin)
glomerulonephritis
vasculitis
contrast
interstitial nephritis
myeloma
rhabdomyolysis

Question 6

how would you expect the U’s and E’s to look from a dehydrated patient?

Answer 6

increase in gross increase in urea, creatinine normal or mildly elevated

albumin and haematocrit may also be raised

Question 7

how is hyperkalaemia diagnosed? What are the ECG findings associated with hyperkalaemia?

Answer 7

VBG

ECG - prelonged PR, stunted p waves, broad QRS, tented/peaked t waves

Question 8

what electrolyte should you correct before attempting to correct a hyperkalaemia?

Answer 8

Mg2+

Question 9

what are the causes of post-renal AKI?

Answer 9

blockage distal to urinary apparatus

kidney stones
pelvic Ca
hydronephrosis
urinary retention
BPH

Question 10

what is the definition of sepsis?

Answer 10

life-threatening organ dysfunction in response to dyspregulated host response to infection

Question 11

what is the definition of septic shock?

Answer 11

lactate +2 despite fluid resuscitation

vasopressor requirements for MAP 65

Question 12

what is the salford criteria of AKI?

Answer 12

Sepsis
A acei, arb, nsAids
L labs- take U + E, cultures
F fluid assessment and response
O obstruction
R renal / ICU referral
D dipstick the urine

Question 13

what are the indications for dialysis in AKI?

Answer 13

not recommended if condition is not life-threatening

A acidosis (metabolic)
E electrolyte imbalances (refractory hyperkalaemia)
I intoxication
O oedema (refractory pulmonary oedema)
U uraemia (clinical syndrome of high urea)

Question 14

what is the definition of sepsis?

Answer 14

life threatening organ dysfunction caused by host responses to infection

Question 15

how is septic shock defined?

Answer 15

lactate >2mmol despite fluid resuscitation

vasopressor requirement for MAP of 65

Question 16

with regards to NICE sepsis risk stratification guidelines, what parameters make a patient high risk?

Answer 16

altered mental state
RR +25
40%FiO2
systolic BP less than 90
tachycardia more than 130bpm
cyanosis, non blanching rash

Question 17

why is it important to check clotting screens in septic patients? (2 reasons)

Answer 17

used as a marker to indicate sepsis severity

septic patients are often in a hypercoagulopathic state which can lead to DIC

Question 18

what are the three phases of acute tubular necrosis? How does creatinine reflect the different phases?

Answer 18

oligouric phase (high creatinine, low UO, often hypervolaemic)
maintenance phase (creatinine normal, pt maintains own fluid balance)
polyuric 'recovery' phase (patients polyuric, can easily become hypovolaemic)

Question 19

by which mechanism do ACEi/ARB cause nephrotoxicity?

Answer 19

efferent renal arteriole dilatation

this lowers glomerular filtration rate

Question 20

by which mechanism do NSAIDs cause nephrotoxicity?

Answer 20

vasoconstriction of afferent arteriole

this can cause pre-renal hypovolaemic AKI

Question 21

what electrolyte marker is used to differentiate between chronic and acute kidney injury?

Answer 21

Calcium

hypocalcaemia in chronic kidney disease