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Renal YR3 > Case 1 - AKI > Flashcards

Case 1 - AKI Flashcards

1
Q

How is AKI staged?

A

Creatinine levels OR urine output

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2
Q

Acute tubular necrosis vs pre-renal cause of uraemia

A
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3
Q

Risk of fatality of AKI

A

Similar to that of MI

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4
Q

What does creatinine levels depend on?

A

Production - eg if large muscle mass breakdown levels will be higher
Poor kidney function - not clearing

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5
Q

Why do we use creatinine for AKI?

A
  • More sensitive marker of disease than eGFR
  • Produced and excreted at constant rate ish
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6
Q

Stage 1 AKI

A
  • 1.5-1.9 baseline creatinine
  • OR 0.3mg/dl or more (26.5 umol/l or more)

OR <0.5ml/kg for 6-12hrs urine output

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7
Q

Stage 2 AKI

A
  • 2-2.9 x baseline
  • OR <0.5mls/kg for 12 hrs or more
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8
Q

Stage 3 AKI

A
  • 3x baseline
  • OR 4mg/dl or more (353.6umol/L or more)

OR
* <0.3mls/kg for 24hrs or more
* or anuria for 12 hrs

OR
* Renal replacement therapy commenced

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9
Q

3 types of causes of an AKI

A
  • Pre renal
  • Renal
  • Post renal
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10
Q

Risk factors for AKI

A
  • Diabetes
  • CKD
  • IHD/CHF/CVD
  • Major medical co-morbiditiy (any)
  • Elderly >75
  • Sepsis
  • Medications - ACEi, ARBs, NSAIDs, Abx
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11
Q

Pre-renal causes of AKI

A
  • Hypovolaemia
  • Decreased CO
  • CHF
  • Liver failure
  • Impaired renal autoregulation
  • NSAIDs
  • ACEi/ARBs
  • Cyclosporine
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12
Q

Intrinsic renal causes of AKI categories

A
  • Glomerular
  • Tubules and intersitium
  • Vascular
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13
Q

Vascular causes of intrinsic AKI

A
  • Vasculitis
  • Malignant hypertension
  • TTP-HUS (thrombotic thrombocytopenia purpura-haemolytic uraemic syndrome)
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14
Q

Tubules and intersitium causes of intrinsic AKI

A
  • Ischaemia
  • Sepsis/infection
  • Nephrotoxins
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15
Q

Examples of exogenous nephrotoxins

A
  • Iodinated contrast
  • Aminoglycosides eg gentamicin
  • Cisplatin
  • Amphotericin B
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16
Q

Examples of endogenous nephrotoxins which cause intrinsic AKI

A
  • Haemolysis
  • Rhabdomyolysis
  • Myeloma
  • Intratubular crystals
17
Q

Post renal causes of AKI

A
  • Bladder outlet obstruction
  • Bilateral pelvoureteral obstruction (or unilateral if only 1 kidney functioning)
18
Q

Investigations for AKI - bedside

A
  • Urine dipstick - protein and blood
    *
19
Q

Bloods for suspected AKI

A
  • FBC
  • U&Es
  • LFTs
  • Bone profile
  • CRP
  • Include serum bicarbonate
  • CK if suspect Rhabdo
20
Q

What test to do if blood and protein on urine dipstick?

A
  • c-ANCA (PR3) and p-ANCA (MPO) - to look for vasculitis
  • Anti GBM, ANA, C3 and C4 - for lupus nephritis
  • Serum immunoglobulins and electrophoresis - to look for myeloma
21
Q

Test if suspect post streptococcal glomerulonephritis

A
  • Anti-streptolysin O titres
22
Q

What to consider if AKI with thrombocytopaenia?

A
  • HUS
  • TTP
  • DIC

Therefore request haemolysis screen

23
Q

Bloods in haemolysis screen

A
  • Blood film
  • LDH
  • Bilirubin
  • Reticulocytes
  • Haptoglobin
    and call Renal SpR urgently
24
Q

When to check cryoglobulins?

A
  • Unexplained rash
  • Peripheral neuropathy
  • Hypocomplementaemia
  • Hepatitis C known
  • History of lymphoproliferative disorder
  • Positive Rh F
25
Q

Management of AKI

A
  • Discontinue nephrotoxic agents
  • Ensure volume status and perfusion pressure - IV fluids if dehydrated, diuretics if overloaded –> euvolaemia
  • Third spaced fluids? - overloaded appearance but JVP and BP low
  • CVP/arterial line for haemodynamic monitoring?
  • Monitor urine output and daily bloods (catheterise if needed)
  • Avoid hyperglycaemia
  • Check for changes needed in drug dosing
  • Treat cause
  • Refer specialist if needing renal replacement therapy
  • Consider ICU admission
26
Q

Indications for RRT

A
  • Hyperkalaemia - resistant to medical therapy
  • Metabolic acidosis - reistant to medical therapy
  • Fluid overload - resistant to diuretics
  • Uraemic pericarditis
  • Uraemic encephalopathy - vomit, confused, drowsiness, reduced conc
  • Intoxications - ethylene glycol, methanol, salicyclates, lithium
27
Q

Fluid assessment involves…

A
  • Capillary refill
  • Skin turgour
  • Pulse and RR
  • BP
  • JVP
  • Mouth dry?
  • Auscultate lungs and heart
  • Abdo - percuss, assess shifting dullness
  • Sacral and leg oedema
  • Weight check
  • Urine output monitoring
28
Q

Drugs to stop in AKI

A
  • Diuretics
  • Aminoglycosides and ACEi
  • Metformin
  • NSAIDs (except aspirin at cardioprotective dose)

DAMN

Also remember lithium toxicity risk increases, consider stopping

Renal YR3 (11 decks)

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