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Stage 4: CSIM 2 > Week 11: AKI > Flashcards

Week 11: AKI Flashcards

1
Q

Most common cause of AKI

A

Prolonged renal hypoperfusion

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2
Q

4 main complications of AKI

A
  1. Hyperkalemia
  2. Accumulation of uraemic toxins
  3. Accumulation of salt and water
  4. Metabolic acidosis
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3
Q

Signs of hyperkalemia

A
  1. Cardiac arrythmias

2. Muscle weakness

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4
Q

Signs/complications of accumulation of uraemic toxins

A
  1. Increased bleeding risk (toxins disallow platelets from sticking together)
  2. Pericarditis, pleuritic pan
  3. N n V
  4. Fits, coma
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5
Q

Signs of salt/ water overload

A
  1. Hypertension

2. Pulmonary oedema

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6
Q

Complications of metabolic acidosis

A
  1. Haemodynamic instability

2. Cell function is disrupted

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7
Q

What creatinine levels make up the 3 AKI warning stages (RIFLE criteria)

A
  1. Creatinine >1.5x baseline in 7 days
    (or >26 umol in 48h)
  2. Creatinine >2x baseline in 7 days
  3. Creatinine >3x baseline in 7 days
    (or >354 umol)
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8
Q

What urine output scores make up the 3 AKI warning stages (RIFLE criteria)

A
  1. <0.5ml/kg/h for >6h
  2. <0.5ml/kg/h for >12h
  3. <0.3ml/kg/h for >24h or anuric for 12h
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9
Q

A 65M weighing 70kg has had a urine output of 280mL in the last 8 hours

What stage of AKI is he in

A

Stage 1

Urine output
= ml/kg/h
= 280 /70/8
= 0.5

0.5ml/kg/h for 8h is Stage 1
(more than 6h, less than 12h)

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10
Q

A 55F weighing 60kg has had a rise of Creatinine of 30umol within the last 48h.

Her creatinine was previous 18umol.

What stage of AKI is she in

A

Stage 1

Increase in creatinine
=30/18
=1.66666
(more than 1.5, less than 2)

Also, increase in creatinine >26umol in last 48h

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11
Q

What 5 chronic conditions can predipose someone to developing AKI

A
  1. Heart failure
  2. Liver disease
  3. T2DM
  4. Atherosclerosis
  5. Anything causing immunocompromise
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12
Q

What type of history may cause you to suspect pre-renal AKI

A
  1. Sepsis symptoms, anything causing hypotension
  2. D n V
  3. Severe bleeding
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13
Q

What type of examination may cause you to suspect pre-renal AKI

A
  1. Sepsis symptoms, anything causing hypotension

2. Fluid overload symptoms: JVP, peripheral/ pulmonary oedema

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14
Q

What investigations can help in diagnosis of pre-renal AKI

A

None

not v helpful

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15
Q

What type of history may cause you to suspect post-renal AKI

A
  1. Obstruction symptoms eg difficulty voiding
  2. Loin pain
  3. Visible haematuria
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16
Q

What type of examination may cause you to suspect post-renal AKI

A
  1. Loin pain

2. Palpable bladder

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17
Q

What investigations can help in diagnosis of post-renal AKI

A

USS

  • hydronephrosis
  • dilated renal pelvis
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18
Q

What type of history may cause you to suspect AKI due to interstitial nephritis

A
  1. Medications
  2. Contrast
  3. Exposure to other toxins
19
Q

What type of history may cause you to suspect AKI due to rhabdomyolysis

A
  1. Myalgia

2. Having lain down for a long time (eg after a fall)

20
Q

What type of history may cause you to suspect AKI due to multiple myeloma

21
Q

What type of history may cause you to suspect AKI due to Haemolytic Uraemic Syndrome

22
Q

What type of history may cause you to suspect AKI due to vasculitis

A
  1. Rash
  2. Arthritis
  3. Haemoptysis
  4. Sinusitis, Epistaxis
  5. Malaise
23
Q

Differential diagnosis for causes of AKI in a pt with rashes

A
  1. Vasculitis

2. Interstitial nephritis

24
Q

Differential diagnosis for causes of AKI in a pt with multiple black spots on skin

A

Cholesterol embolus

25
What investigation is required for diagnosis of haemolytic uraemic syndrome
Blood film
26
What conditions (that cause AKI) can renal biopsy diagnose
1. Glomerulonephritis | 2. Interstitial nephritis
27
Small kidneys on USS are more associated with AKI/CKD
Small kidneys = CKD
28
Pre-renal causes of AKI due to lower circulating blood volume
1. Massive bleed 2. Burns 3. Dehydration 4. V n D 5. Diuretics
29
5 Pre-renal causes of AKI due to lower circulating blood volume
1. Massive bleed 2. Burns 3. Dehydration 4. V n D 5. Diuretics
30
4 Pre-renal causes of AKI due to lower cardiac output
1. Heart failure 2. MI 3. Cardiac tamponade 4. Severe PE
31
3 Pre-renal causes of AKI due to hypotension
1. Sepsis 2. Anaphylactic shock 3. Pancreatitis/ other hepatorenal causes
32
Pre-renal cause of AKI due to medication
NSAIDs | -cause vasoconstriction of afferent kidney arteriole
33
5 Post-renal causes of AKI due to anatomical causes
URINARY TRACT OBSTRUCTION DUE TO 1. Large prostate 2. Pelvic/ abdo mass 3. Kidney/ renal tract stones 4. Retention secondary to UTI/ constipation 5. Congenital obstructive uropathy (in neonates)
34
Post-renal cause of AKI due medication
Antimuscarinic (may cause retention)
35
3 Glomerulus causes of intrinsic AKI
1. Glomerulonephritis (including vasculitis) 2. Haemolytic uraemic syndrome 3. Cholesterol micro-emboli
36
4 Tubular-insterstitium causes of intrinsic AKI
1. Acute interstitial nephritis (allergic) 2. Acute tubular necrosis 3. Tubular obstruction by casts 4. Pyelonephritis (if this causes severe sepsis)
37
Pathophysiology of acute interstitial nephritis
Allergic reaction causing inflammatory infiltrate around tubules
38
Causes of acute interstitial nephritis
1. NSAIDs, PPIs 2. Aminoglycosides, Penicillin 3. Contrast 4. Sarcoidosis
39
Pathophysiology of acute tubular necrosis
Ischaemia in proximal tubular cells
40
Causes of acute tubular necrosis
1. Prolonged renal hypoperfusion | 2. Nephrotoxic drugs (ACEi, ARBs, loop diuretics, aminoglycosides)
41
Causes of tubular obstruction by casts (4 cast types + conditions that cause them)
1. Paraprotein (myeloma) 2. Myoglobin (rhabdomyolysis) 3. Urate (tumour lysis) 4. Crystals (drugs, alcohol)
42
What drugs should be stopped in AKI
1. ACEi/ ARB 2. NSAIDs Note: Diuretics are not nephrotoxic. Stop/ continue depending on fluid status
43
What drug levels may accumulate in reduced kidney function
1. Metformin 2. Morphine 3. LMWH
44
When do you use a catheter/ nephrostomy
Catheter: obstruction at/below bladder level Nephrostomy: obstruction above bladder

Stage 4: CSIM 2 (47 decks)

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