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Urinary > Week 10 > Flashcards

Week 10 Flashcards

1
Q

What is AKI

A

Abrupt decline in renal function (GFR)

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2
Q

Criteria for AKI

A

Serum creatinine increases by >1.5x baseline

Urine output <0.5ml/kg/hour for 6 hours

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3
Q

Classification of AKI

A

Pre renal
Intrinsic
Post renal

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4
Q

Broad causes of pre renal failure

A

Low effective circulating volume

Impaired renal auto regulation

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5
Q

What can cause low ECV

A

Hypovolaemia - blood or fluid loss (D&V
Cardiac failure - LV dysfunction, cardiac tamponade, valve disease
Systemic vasodilation - sepsis, anaphylaxis, cirrhosis

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6
Q

What can cause impaired renal auto regulation

A

Afferent vasoconstriction - sepsis, NSAIDs, hypercalcaemia

Efferent vasodilation - ACEi, AT2 receptor antagonists

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7
Q

Treatment and outcome of pre renal failure

A

Aldosterone and ADH are released to restore blood flow
Responds well to fluid resuscitation
Will progress to ATN without treatment

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8
Q

Causes of intrinsic renal failure

A 
Renal artery/vein occlusion
Acute glomerulonephritis 
Acute tubular necrosis
Acute tubular interstitial nephritis 
Intra renal obstruction
Intra renal vascular disease
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9
Q

Describe acute tubular interstitial nephritis

A

Inflammation of intersticium
Due to:
Infection - acute pyelonephritis
Toxin - antibiotics, PPIs, NSAIDs

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10
Q

Do you give fluid resuscitation for ATN

A

No

Risks volume overload

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11
Q

Causes of ATN

A

Ischaemia - usually secondary to pre renal failure
Nephrotoxins
Sepsis

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12
Q

What is most affected in ATN and why

A

S3 segment

High metabolic acid and has a nearly hypoxic supply with normal perfusion

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13
Q

Difference between pre renal failure and ATN

A

Urine Na is low in pre renal and high in ATN

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14
Q

Endogenous nephrotoxins

A

Urate
Billirubin
Myoglobin (rhabdomyolosis)

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15
Q

Exogenous nephrotoxins

A 
Loop diuretics
Aminoglycosides 
ACE inhibitors
Endotoxins
XR contrast
NSAIDs 
Weedkiller
Antifreeze
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16
Q

What must occur for post renal failure to occur

A

Obstruction blocking both kidneys or a single functioning kidney

17
Q

Causes of post renal failure

A

Lumen - stones, tumour, blood clot, papillary necrosis
Wall - neurogenic bladder, megaureter, pelivureteric neuromuscular dysfunction, bilateral Ureteric stricture
Pressure from outside - BPH, tumour, abdominal aneurysm, ligation of ureter

18
Q

What does post renal failure cause

A

Hydronephrosis

19
Q

Investigations for AKI

A

Urea
Creatinine
K, Na, Ca and PO4
(In serum and urine)

20
Q

Investigations for pre renal AKI

A

Look for shock and vascular disease

21
Q

Investigations for intrinsic AKI

A

Nephrotoxins
Parenchymal disease
Multi system diseases e.g UTI

22
Q

Investigations for post renal AKI

A

Anuria

Prostatism

23
Q

Signs of depleted volume

A 
Cool peripheries
Tachycardia
Low BP
Low JVP
Low skin turgor
Dry axillae 
Sunken eyes
24
Q

Signs of volume overload

A

Gallop rhythm
High BP
Raised JVP
Pulmonary, ankle and sacral oedema

25
Q

Signs of urinary tract obstruction

A 
Anuria
Loin or suprapubic pain
History of renal stones
Previous pelvic or abdominal surgery
Palpable bladder or kidney
Prostatism
26
Q

Urine investigations for AKI

A 
Urine dipstick - proteins and blood = intrinsic
Microscopy:
Normal = pre renal 
RBC casts = glomerulonephritis 
Muddy brown granular casts = ATN
27
Q

Imaging for AKI

A

Ultrasound within 24 hours if unknown cause or suspected post renal AKI
Biopsy if pre and post renal have been ruled out
CXR to look for fluid overload or infection

28
Q

Antibody detection in intrinsic AKI

A

Antinuclear antibody - SLE
Anti neutrophil cytoplasmic antibody - vasculitis
Collagen IV glomerular BM antibody - Good pastures syndrome

29
Q

Treatment of AKI

A

Volume overload - restrict dietary Na and water
Hyperkalaemia - calcium gluconate, insulin, glucose
Acidosis - NaHCO3
Nutrition
Remove nephrotoxins (might need dialysis or chelation)
Dialysis if no improvement

30
Q

First line investigation in asymptomatic glomerular disease picked up by urine dipstick (protein and bloods)

A

Flexible cystoscopy

31
Q

Appearance of macroscopic haematuria with glomerular disease

A

Brown

Episodic

32
Q

Reasons for brown urine

A

Glomerular disease
Haemoglobinuria
Myoglobinuria
Consumption of food dyes

33
Q

Commonest cause if macroscopic haematuria

A

IgA nephropathy

Urinary (6 decks)

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