Vula 100 Cards

Question 1

what is AKI?

Answer 1

Definition of AKI:
Sudden kidney dysfunction with loss of glomerular filtration leading to electrolyte and fluid abnormalities.

Difference between AKI and CKD:
AKI is reversible and sudden, while CKD is persistent over at least three months.

Markers for AKI:
Increase in serum creatinine or decrease in urine output.

Markers for CKD:
Decrease in Glomerular Filtration Rate (GFR).

KDIGO criteria for AKI:
Creatinine 1.5-2x baseline or urine output <0.5 mL/kg/h.

Importance of AKI: Associated with worse outcomes and high ICU and hospital admission rates.

Question 2

Differentiate between AKI and CKD

Answer 2

AKI is reversible and sudden.
It markers: Increase in serum creatinine or decrease in urine output.
KDIGO criteria for AKI: Creatinine 1.5-2x baseline or urine output <0.5 mL/kg/h.

CKD is persistent over at least three months. It clinical marker is: Decrease in Glomerular Filtration Rate (GFR).

Question 3

Classify AKI

Answer 3

Prerenal, Intrinsic, Postrenal.

Prerenal AKI:
Due to decreased blood flow to the kidneys.

Intrinsic AKI:
Due to direct damage to kidney structures.

Postrenal AKI:
Due to obstruction of urine flow.

Question 4

Outline approach to prerenal AKI

Answer 4

Prerenal AKI: Due to decreased blood flow to the kidneys.

Ddx:

Prerenal AKI causes: Hypovolemia, hypotension, renal artery vascular diseases and other.

1. Hypovolemia causes: Decreased intake, increased losses, diuretic use, blood loss.
2. Hypotension causes: Shock state, heart failure, antihypertensive use.
3. Renal artery diseases: Stenosis, thromboembolic events, NSAID/ARB/ACE inhibitor use.
4. Other : Hepatorenal disease, renal vein thrombosis, aortic dissection.

Risk factors for prerenal AKI:
1. Hypovolemia,
2. heart failure,
3. shock.

Clues for prerenal AKI:
1. Hypotension,
2. tachycardia,
3. vomiting, diarrhea, blood loss.

(By etiology and by consequence

By etiology: Patients with Prerenal Acute Kidney Injury may present with hypotension, tachycardia, shock, peripheral edema, vomiting, diarrhea, acute blood loss, flank or back pain, oliguria or anuria.

By consequence: Acute kidney injury may present with a variety signs and symptoms consistent with uremia, electrolyte disturbances, and fluid status. These may include third spacing with shortness of breath, pleural and pericardial effusions, interstitial edema, and ascites. Hyperkalemia may present with acutely life-threatening arrhythmias and requires emergent diagnosis and management. Uremia may present with uremic pericarditis, effusion and life-threatening pericardial tamponade requiring emergent diagnosis and management. Acute hypertension with hypertensive emergency also requires emergent management.)o

Presentation - Symptoms of prerenal AKI:
1. Dizziness,
2. dry mucous membranes,
3. low blood pressure.

Work up in ED - check separate card

Management of prerenal AKI

1. Admission criteria for AKI: KDIGO definition and close follow-up needed.
2. Treatment for prerenal AKI: IV fluid resuscitation.

Patients meeting the KDIGO definition for AKI typically require admission to the hospital (if etiology is identified/addressed and close follow-up established then reliable patients can be discharged – shared decision-making).

Question 5

Outline approach to intrinsic AKI

Answer 5

Intrinsic AKI: Due to direct damage to kidney structures.

Ddx:

Intrinsic AKI categories: Interstitial, glomerular, nephrotoxins.

1. Interstitial diseases: Pyelonephritis, amyloid, autoimmune (SLE), drug-induced nephritis.
2. Glomerular diseases: Post-infectious glomerulonephritis, HSP, SLE, Wegener’s.
3. Nephrotoxins: NSAIDs, aminoglycosides,
   radiocontrast, heme from rhabdomyolysis.

Risk factors for intrinsic AKI:
1. Infections,
2. autoimmune diseases,
3. nephrotoxins.

Clues for intrinsic AKI:
1. Flank pain,
2. hematuria, proteinuria, urinary casts.

Intrinsic Acute Renal Injury may present with flank and back pain, hematuria, proteinuria, urinary casts and sediments, infectious prodrome, and history or presentation of systemic diseases causing microangiopathy and hemolysis like HUS, TTP, scleroderma, and DIC.

…

Symptoms of intrinsic AKI:
1. Flank pain,
2. hematuria,
3. malaise.

Inv: separate

Tx

Eliminate nephrotoxins: Discontinue harmful medications or treatments.

Etc