kidney stones and AKI

Question 1

how common are kidney stones?

Answer 1

1 in 10 people get them

Question 2

risk factors for kidney stones

Answer 2

family history
trauma
reflux
horseshoe kidney 
obstruction 
urate
dehydration 
high calcium

Question 3

pathology of kidney stones

Answer 3

formation of crystals from supersaturated urine
80% calcium based
10% uric acid (not seen on XR)
5-10% struvite (infection related)
1% cysteine

Question 4

signs of kidney stones

Answer 4

loin pain is unilateral 
history of not being able to depress pain 
radiation of pain to ipsilateral groin 
nausea 
'worse than labour'
rapid onset

Question 5

symptoms of kidney stones

Answer 5

loin pain 
renal colic
UTI symptoms (dysuria, strangury, urgency, frequency)
recurrent UTIs
haematuria

Question 6

complications of kidney stones

Answer 6

long term damage
sepsis
post renal AKI

Question 7

diagnosis of kidney stones

Answer 7

urinalysis
imaging (mostly CT)
ureteroscopy

Question 8

treatment of uric acid stones

Answer 8

deacidification of urine

Question 9

treatment of cystine stones

Answer 9

excessive hydration

Question 10

treatment of kidney stones

Answer 10

ureteric stent for drainage

nephrostomy

Question 11

prevention of kidney stones

Answer 11

over hydration
low sodium diet
healthy protein intake
active lifestyle

Question 12

acute kidney injury risk factors

Answer 12

sepsis
major surgery 
cardiogenic shock 
hypovolaemia
drugs 
obstruction 
hepatorenal syndrome
age
male
comorbidity

Question 13

cause of pre-renal AKI

Answer 13

perfusion to kidney - shock, fluid loss

Question 14

cause of renal AKI

Answer 14

intrinsic renal disease

trauma

Question 15

cause of post-renal AKI

Answer 15

obstruction to urine - stones, cancer

Question 16

diagnosis of AKI

Answer 16

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

Question 17

indications for dialysis in AKI

Answer 17

refractory oedema 
persistent hyperkalaemia
severe metabolic acidosis
uraemic encephalopathy 
pericarditis

Question 18

drug overdoses that will cause AKI

Answer 18

BLAST 
Barbiturate
Lithium 
Alcohol ethylene glycol 
Salicylate
Theophylline

Question 19

complications of AKI

Answer 19

the kidneys stop making urine and fluid goes everywhere - esp. the lungs –> refractory pulmonary oedema

Question 20

treatment of pre-renal AKI

Answer 20

correct volume depletion and renal perfusion via circulatory/cardiac support
treat any underlying sepsis

Question 21

treatment of renal AKI

Answer 21

refer for biopsy and specialist treatment of intrinsic renal disease

Question 22

treatment of post-renal AKI

Answer 22

catheter, nephrostomy, or urological intervention

Question 23

general management of AKI

Answer 23

manage fluid balance
manage acidosis
manage hyperkalaemia
recognise in time if pt needs renal replacement

Question 24

how to manage a patient who comes in with high creatinine

Answer 24

give IV fluids

- but if AKI if due to heart failure, giving fluids will make it worse

Question 25

how to manage hyperkalaemia

Answer 25

insulin and dextrose
salbutamol 
calcium 
gluconate
IV fluids