Hospital Nephrology 1

Question 1

What are the 2 common systems used to stage AKI and what changes do they use and what limits are imposed?

Answer 1

RIFLE and AKIN

Changes in SrCr and UO

AKIN - 48 hour limit on SrCr rise
RIFLE - 7 day “ “

Question 2

What causes pre renal AKI?

Answer 2

Hypovolaemia
Loss of peripheral resistance
Reduced cardiac output
Renovascular obstruction

Question 3

Which drugs can cause pre renal AKI?

Answer 3

Excessive use of diuretics, laxatives

NSAIDS
ACEis

Question 4

What three categories can intrinsic AKI be divided into?

Answer 4

Pre glomerular
Glomerular
Post glomerular

Question 5

What drugs can cause intrinsic AKI?

Answer 5

Glomerular - drugs act as allergens: gold, captopril and allopurinol

Tubular - drugs act as direct toxins on tubules: amino glycosides and ciclosporin

Interstitial- hypersensitivity reaction due to drugs: carbamazepine, thiazides , penicillins and PPIs

Question 6

What cause post renal AKI?

Answer 6

Bladder outflow

Ureteric obstruction

Question 7

How is urine volume a complication of AKI?

Answer 7

Oliguria
Anuria
Polyuria

Question 8

Will urea and creatinine levels be elevated in AKI?

Answer 8

Yes

Question 9

Is metabolic acidosis common in AKI and how is it characterised?

Answer 9

Yes

By low plasma bicarbonate

Question 10

How is electrolyte imbalances a consequence of AKI?

Answer 10

Limited potassium excretion - hyperkalemia

Hyponatraemia - due to dilutional effect of fluid overload

Hypocalcaemia - reduction in alpha 1 hydroxylase activity in kidney

Question 11

What are the consequences of Uraemia?

Answer 11

Diminished levels of consciousness, confusion, disorientation and coma

Can cause nausea, vomiting, itching and pericarditis

Increased risk of GI haemorrhage

Question 12

What are the 8 primary preventions of AKI?

Answer 12

Recognised and assess high risk patients 
Assess fluid balance 
Avoid nephrotoxic agents 
Obtain level of baseline renal function 
Treat infection early 
Maintain an effective circulatory volume 
Recognise and treat hypoxia 
Check for acidosis

Question 13

When should we dialyse?

Answer 13

Hyperkalemia refractory to medical management

Acidosis refractory to medical management
Uraemia - pericarditis and encelopathy
Fluid overload refractory to medical
Management

Question 14

How is AKI defined?

Answer 14

Increase in serum creatinine by greater than 26.5 micromoles/L with in 48hrs or

Increase in serum creatinine to greater than 1.5 times baseline or by urine volume increase greater than 0.5ml/kg/h for 6 hrs