PassMedicine Flashcards
def of acute kidney injury
AKA acute renal failure
reduction in renal function
what is the inpatient mortality of AKI in the UK
25%
what are the causes of AKI divided into
1 prerenal
2 intrinsic
3 post renal
what are the prerenal causes of AKI
lack of blood flow to kidnets
1 hypovolaemia (secondary to D/V)
2 renal artery stenosis
what are the intrinsic causes of AKI
damage to kidney itself 1 glomerulonephritis 2 acute tubular necrosis 3 acute interstitial nephritis 4 rhabdomyolysis
what are the postrenal causes of AKI
obstruction causing urine to ‘back-up’
1 kidney stones in ureter or bladder
2 benign prostatic hyperplasia
3 external compression of ureter
risk factors of AKI
1 chronic kidney disease
2 heart failure/DM
3 history of AKI
4 nephrotoxic drugs
what drugs have nephrotoxic potential
NSAIDs
aminoglyclosides (gentamicin, streptomycin)
ACE inhibitors + ARBs
diuretics
symptoms and signs of AKI
reduced urine output
pulmonary/peripheral oedema
arrythmias (due to change in potassium)
how is AKI detected
1 rise in serum creatinine >26micromol/l in 48h
2 >50% rise in serum creatinine in last 7 days
3 a fall in urine output to <0.5ml/kg/hr for >6hrs
what drugs are used in hyperkalaemia treatment
1 IV calcium gluconate 2 combined insulin/dextrose infusion 3 nebulised salbutamol 4 calcium resonium 5 loop diuretics
how does combined insulin/dextrose infusion and nebulised salbutamol work against hyperkalaemia
causes short-term shift of K form extracellular to intracellular
how do calcium resonium and loop diuretics work against hyperkalaemia
removal of K from body
what must be stopped in AKI which due to increased risk of toxicity (but doesnt usually worsen AKI itself)
metformin
lithium
digoxin
what happens to H+ levels as K+ rises
hyperkalaemia is associated with acidosis because as potassium levels rise, fewer H+ ions enter the cells
what are causes of hypokalaemia with alkalosis
vomiting
diuretics
Cushings + Conns
A 35-year-old man presents with severe, episodic loin pain which radiates round to the front. He has blood+++, leucocytes ++ on the urine dipstick
renal colic
what is usually safe to continue in AKI
paracetamol warfarin statins aspirin clopidogrel BBs
what is primary hyperaldosteronism associated with
hypokalaemia
what stimulates ADH release
angiotensin II
what increases Na reabsorption in the renal distal tubule
aldosterone
what increases proximal tubule Na/H activity
angiotensin II
what is Granular appearance on immunofluorescence associated with
post-streptococcal glomerulonephritis
SLE nephropathy (class IV)
membranous glomerulonephritis
what can blood in the urine be split up into
microscopic
macroscopic
