kidney stones and AKI Flashcards
Information about renal colic and acute kidney injury.
how common are kidney stones?
1 in 10 people get them
risk factors for kidney stones
family history trauma reflux horseshoe kidney obstruction urate dehydration high calcium
pathology of kidney stones
formation of crystals from supersaturated urine 80% calcium based 10% uric acid (not seen on XR) 5-10% struvite (infection related) 1% cysteine
signs of kidney stones
loin pain is unilateral history of not being able to depress pain radiation of pain to ipsilateral groin nausea 'worse than labour' rapid onset
symptoms of kidney stones
loin pain renal colic UTI symptoms (dysuria, strangury, urgency, frequency) recurrent UTIs haematuria
complications of kidney stones
long term damage
sepsis
post renal AKI
diagnosis of kidney stones
urinalysis
imaging (mostly CT)
ureteroscopy
treatment of uric acid stones
deacidification of urine
treatment of cystine stones
excessive hydration
treatment of kidney stones
ureteric stent for drainage
nephrostomy
prevention of kidney stones
over hydration
low sodium diet
healthy protein intake
active lifestyle
acute kidney injury risk factors
sepsis major surgery cardiogenic shock hypovolaemia drugs obstruction hepatorenal syndrome age male comorbidity
cause of pre-renal AKI
perfusion to kidney - shock, fluid loss
cause of renal AKI
intrinsic renal disease
trauma
cause of post-renal AKI
obstruction to urine - stones, cancer
diagnosis of AKI
rise in creatinine >26 umol/L within 48hours
rise in creatinine >1.5x baseline within 7 days
urine output <0.5mL/kg/hr for >6 consecutive hours
indications for dialysis in AKI
refractory oedema persistent hyperkalaemia severe metabolic acidosis uraemic encephalopathy pericarditis
drug overdoses that will cause AKI
BLAST Barbiturate Lithium Alcohol ethylene glycol Salicylate Theophylline
complications of AKI
the kidneys stop making urine and fluid goes everywhere - esp. the lungs –> refractory pulmonary oedema
treatment of pre-renal AKI
correct volume depletion and renal perfusion via circulatory/cardiac support
treat any underlying sepsis
treatment of renal AKI
refer for biopsy and specialist treatment of intrinsic renal disease
treatment of post-renal AKI
catheter, nephrostomy, or urological intervention
general management of AKI
manage fluid balance
manage acidosis
manage hyperkalaemia
recognise in time if pt needs renal replacement
how to manage a patient who comes in with high creatinine
give IV fluids
- but if AKI if due to heart failure, giving fluids will make it worse
how to manage hyperkalaemia
insulin and dextrose salbutamol calcium gluconate IV fluids
