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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

A

Back pain

21
Q

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

A

Diarrhoea

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
Q

What investigation is required for diagnosis of haemolytic uraemic syndrome

A

Blood film

26
Q

What conditions (that cause AKI) can renal biopsy diagnose

A
  1. Glomerulonephritis

2. Interstitial nephritis

27
Q

Small kidneys on USS are more associated with AKI/CKD

A

Small kidneys = CKD

28
Q

Pre-renal causes of AKI due to lower circulating blood volume

A
  1. Massive bleed
  2. Burns
  3. Dehydration
  4. V n D
  5. Diuretics
29
Q

5 Pre-renal causes of AKI due to lower circulating blood volume

A
  1. Massive bleed
  2. Burns
  3. Dehydration
  4. V n D
  5. Diuretics
30
Q

4 Pre-renal causes of AKI due to lower cardiac output

A
  1. Heart failure
  2. MI
  3. Cardiac tamponade
  4. Severe PE
31
Q

3 Pre-renal causes of AKI due to hypotension

A
  1. Sepsis
  2. Anaphylactic shock
  3. Pancreatitis/ other hepatorenal causes
32
Q

Pre-renal cause of AKI due to medication

A

NSAIDs

-cause vasoconstriction of afferent kidney arteriole

33
Q

5 Post-renal causes of AKI due to anatomical causes

A

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
Q

Post-renal cause of AKI due medication

A

Antimuscarinic (may cause retention)

35
Q

3 Glomerulus causes of intrinsic AKI

A
  1. Glomerulonephritis (including vasculitis)
  2. Haemolytic uraemic syndrome
  3. Cholesterol micro-emboli
36
Q

4 Tubular-insterstitium causes of intrinsic AKI

A
  1. Acute interstitial nephritis (allergic)
  2. Acute tubular necrosis
  3. Tubular obstruction by casts
  4. Pyelonephritis (if this causes severe sepsis)
37
Q

Pathophysiology of acute interstitial nephritis

A

Allergic reaction causing inflammatory infiltrate around tubules

38
Q

Causes of acute interstitial nephritis

A
  1. NSAIDs, PPIs
  2. Aminoglycosides, Penicillin
  3. Contrast
  4. Sarcoidosis
39
Q

Pathophysiology of acute tubular necrosis

A

Ischaemia in proximal tubular cells

40
Q

Causes of acute tubular necrosis

A
  1. Prolonged renal hypoperfusion

2. Nephrotoxic drugs (ACEi, ARBs, loop diuretics, aminoglycosides)

41
Q

Causes of tubular obstruction by casts (4 cast types + conditions that cause them)

A
  1. Paraprotein (myeloma)
  2. Myoglobin (rhabdomyolysis)
  3. Urate (tumour lysis)
  4. Crystals (drugs, alcohol)
42
Q

What drugs should be stopped in AKI

A
  1. ACEi/ ARB
  2. NSAIDs

Note: Diuretics are not nephrotoxic. Stop/ continue depending on fluid status

43
Q

What drug levels may accumulate in reduced kidney function

A
  1. Metformin
  2. Morphine
  3. LMWH
44
Q

When do you use a catheter/ nephrostomy

A

Catheter: obstruction at/below bladder level

Nephrostomy: obstruction above bladder

Stage 4: CSIM 2 (47 decks)

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