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Y2 - Urinary > Lecture 11 - Acute Kidney Injury (AKI) > Flashcards

Lecture 11 - Acute Kidney Injury (AKI) Flashcards

1
Q

What is Acute Kidney injury (AKI)?

A

A sudden deterioration of renal function over hours to days

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2
Q

What metabolic products rapidly rise in AKI?

A

Urea
Creatinine

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3
Q

What usually happens to urine output in an AKI?

A

Oliguria
Or
Anuria

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4
Q

What is oliguria?

A

Reduced urine output
100ml - 400ml

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5
Q

What is Anuria?

A

No urine output or <100ml

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6
Q

What is Uraemia?

A

Clinical symptoms which arise when nitrogenous metabolic waste products accumulate in the blood (urea and creatinine) as a result of decreased filtration of these products by the kidney

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7
Q

What is the likely cause of patients pathology:

High creatinine
Reduced eGFR
Hypotrophic kidneys

A

Chronic kidney disease

Since the deterioration/reduced function in the kidneys leads to kidney tissue shrinkage

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8
Q

What diuretic is most appropriate in a patient with pulmonary oedema?

What type of diuretic is it?

How does it work?

A

Loop Diuretic

Blocks the NKCC channel in the ascending limb of loop of Henle
Reduces reabsorption of Na+ so more Na+ stays in lumen
This impairs the corticopapillary gradient so less water gets reabsorbed in the CD
More water lost in urine

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9
Q

What are the stages of an AKI?

A

1
2
3

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10
Q

What 2 things can be measured to determine stage of an AKI?

A

Serum creatinine

Urine output

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11
Q

What are the serum creatinine levels in stage 1 AKI?

What are the urine output levels in a stage 1 AKI?

A

Serum creatinine = 1.5 - 1.9 times baseline

Urine output = <0.5ml/kg/h between hours 6 and 12

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12
Q

What are the serum creatinine levels in stage 2 AKI?

What are the urine output levels in a stage 2 AKI?

A

Serum creatinine = 2 - 2.9 times baseline

Urine output = <0.5ml/kg/h for more than 12hrs

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13
Q

What are the serum creatinine levels in stage 3 AKI?

What are the urine output levels in a stage 3 AKI?

A

Serum creatinine = 3 times baseline or serum creatinine > 353.6mmol/L

Urine output = <0.3ml/kg/h for 24hrs or more
Or
Anuria for 12hrs or more

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14
Q

Stage the AKI on Slide 8

A

70ml urine output
70ml / 6 = 11.67ml/h
11.67 / 69kg = 0.17ml/kg/h

0.17ml/kg/h between 6-12 so STAGE 1 AKI

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15
Q

What are the 3 types of cause of AKI?

A

Pre-renal AKIs
Intrinsic renal AKIs
Post renal AKIs

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16
Q

What are some causes of Pre-renal AKIs?

A

Sepsis
Hypovolaemia
Shock
Renal artery stenosis
Congestive Cardiac Failure (CCF)
NSAIDs
ACE inhibitors

Essentially anything that leads to reduced perfusion of kidneys

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17
Q

How does Sepsis cause Pre-renal AKIs?

A

Toxins lead to systemic vasodilation

Massive drop in BP

Leads to Renal hypoperfusion

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18
Q

How does Hypovoloaemia cause Pre-renal AKIs?

A

Reduced kidney perfusion

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19
Q

How does shock cause Pre-renal AKIs?

A

Catastrophic fall in BP
Hypovolaemic
Leads to renal hypoperfusion

20
Q

How does Renal artery stenosis cause Pre-renal AKIs?

A

Occlusion of renal artery
Leads to reduced perfusion of kidney

21
Q

How does Congestive Cardiac Failure cause Pre-renal AKIs?

A

Reduced cardiac output
Less blood to kidneys

22
Q

How do NSAIDs cause Pre-renal AKIs?

A

Blocks prostaglandins so kidneys cant vasodilates afferent arteries or renal artery so reduced blood flow to it

23
Q

How do ACE inhibitors cause Pre-renal AKIs?

A

Can’t restore BP if it drops
RAAS system cant be activated

Leads to renal hypoperfusion

24
Q

What are some intrinsic renal causes of AKI?

A

Acute tubular necrosis
Acute interstitial nephritis
Glomerular disease
Vasculitis

25
Q

How does Acute Tubular necrosis cause Intrinsic-renal AKIs?

What can cause Acute Tubular necrosis?

A

Toxins can cause cell necrosis leading to acute tubular necrosis

Rhabdomyolysis - myoglobin is toxin to the kidney

26
Q

What is Acute Interstitial nephritis?

A

Inflammation in kidney

27
Q

What happens in glomerular disease causing intrinsic Renal AKI?

A

Where the glomerular capilaries are destroyed

28
Q

What is vasculitis?

How can it cause intrinsic renal AKI?

A

Inflammation of blood vessels in kidney

29
Q

What are the general causes of post-renal AKI?

A

Anything that blocks the urine output

So anything after urine leaves kidney

30
Q

What are some post-renal causes of AKI?

A

Bilateral calculus
Uteric/urethral stricture
BPH
Tumor
Retro-peritoneal fibrosis

31
Q

What is Calculus?

Why does the calculus have to be bilateral to cause post renal AKI?

A

Urinary stones

If on one side the other kidney can filter the blood

32
Q

How does a Uteric/urethral stricture cause post-renal AKI?

A

Blocks urine outflow

33
Q

How does a BPH cause post-renal AKI?

A

Enlarged prostate squeezes the prostatic urethra

34
Q

How does a retro-peritoneal fibrosis cause post-renal AKI?

A

Pushes ureters from outside compressing them

35
Q

What are the 4 main complications of AKI?

A

Metabolic acidosis
Hyperkalaemia
Uraemia
Volume overload

36
Q

How does metabolic acidosis occur with AKI?

A

Reduced GFR kidney not filtering as much

Less able to reabsorb and produce HCO3-

37
Q

How does hyperkalaemia occur with AKI?

A

Low GFR means less able to remove K+

The hyperkalaemia also contributes to the metabolic acidosis

38
Q

How does volume overload happen with AKI?

A

Less able to remove water due to reduced GFR

39
Q

What bedside investigations can be done to check for AKI?

A

Bladder scan
Urinalysis, microscopy, culture and specimen
ECG (to see any effects of K+)

40
Q

What blood investigations can be done for AKI?

A

VBG
Creatinine kinase (rhabdomyolysis)
Immunology screen (vasculitis)

41
Q

What imaging investigations can be done for AKI?

A

Ultrasound of Kidneys, ureters and Bladder
CT scan
CXR

42
Q

What is a nephrostomy?

A

Bag which drains the contents of the kidney

43
Q

What is cytoscopy?

A

Camera into bladder

44
Q

What are some treatments for a Pre-renal AKI?

A

Treat underlying cause

IV fluids (Hypovolaemia)
Stop potentially Nephrogenic medication (NSAIDs ACE inhibitors
Diuretics

45
Q

What are some treatments for intrinsic renal AKIs?

A

Correct electrolytes
Renal replacement therapy
Call nephrology

46
Q

What are some post-renal treatments of AKI?

A

Urinary or suprapubic Catheter

Ureteric stents

Nephrostomy

Y2 - Urinary (24 decks)

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