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Year 2(B7) - Renal > Week 5 - B - Acute kidney injury lecture (more depth) > Flashcards

Week 5 - B - Acute kidney injury lecture (more depth) Flashcards

1
Q

What did acute kidney injury used to be known as?

A

Acute renal failre

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2
Q

What is acute kidney injury defined as?

A

Rapid reduction in renal function over hours/days as defined by measuring the serum urea and creatinine

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3
Q

What are the measurements for diagnosing acute kidney injury?

A

Rise in serum creatinine by 26.4micromoles/l in the past 48 hours Serum creatinine level has risen over time (by 50% or more within the past 7 days) Oliguria (less than 0.5ml per kg per hour for more than 6 hours) (less than 400mls per day)

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4
Q

is acute kidney injury a description or a ddiagnosis?

A

Acute kidney injury is a description , not a diagnosis

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5
Q

Acute kidney injuries can arise from 3 ways Name the 3 ways?

A

Pre renal Renal Post renal

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6
Q

What are causes of pre renal AKI?

A

o Hypovolaemia  Major haemorrhage  Volume depletion (diarrhoea + vomiting, burns) Also drugs NSAIDs and ACEi/ARBS

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7
Q

What is the name of the syndrome that can also cause AKI?

A

Hepatorenal syndrome - life-threatening medical condition that consists of rapid deterioration in kidney function in individuals with cirrhosis or fulminant liver failure.

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8
Q

How does the liver cirrhosis lead to kidney failure in hepatorenal syndrome? What drug can be given for treatment?

A

Cirrhosis - causes portal hypertension - causes splanchnic vasodilation Decreases effective arterial blood volume Activation of RAAS system Causes renal vasoconstriction Kidneys become underperfused HEPATORENAL SYNDROME OCCURS -treat wth terlipressin for the kidneys

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9
Q

If there is a decrease in renal perfusion, what is the normal physiological response?

A

Decrease in renal perfusion cuases the RAAS system to act, this causes angiotensin 2 to vasoconstriction the efferent arteriole leading to a minatined GFR

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10
Q

If a patient is hypotensive, why would giving an ACE inhibtor precpitate AKI?

A

Will cause vasodilation of the effernet arteriole leading to a decreased GFR - worsen the oliguria

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11
Q

The kidneys are 0.5% of body weight What percentage of the cardiac output do they receive?

A

Receive 20% of the cardiac output

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12
Q

What does untreated AKI lead to?

A

This will lead to acute tubular necorosis

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13
Q

What is the treatment of pre renal acute renal failure?

A

Control the hypovalaemia by giving IV fluids

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14
Q

What are other causes of acute tubular necrosis that isnt hypovalaemia?

A

Common causes include sepsis and severe dehydration Other important causes include rhabdomyolysis and drug toxicity

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15
Q

How does rhabdomyolysis cause acute kidney injury?

A

Due to eg a woman has fallen and laid on the foor for days, sskeletal muscle breaks down releasing myoglobin, this is toxic to the kidneys and cause acute tubular necrosis causing acute kidney injury

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16
Q

Diseases causing inflammation or damage to cells causing AKI This is renal AKI What are some things that can cause this?

A

Ischaemia to the kidneys, drugs, vasculitis, glomerulonephritis , interstitial nephritis

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17
Q

What can cause interstitial nephritis?

A

NSAID s, infection eg TB and sarcoidosis

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18
Q

What are some clues to vascutiis/glomerulonephritis causes?

A

Sore throat, haemopytisis , join pain

19
Q

What investigation can cause AKI if you do not hydrate the patinet?

A

Contrast CT scan

20
Q

What type of urinary casts are specific to acute tubular necrosis?

A

Muddy brown casts

21
Q

What is the most common causes of renal AKI?

A

wegeners granulomatosis (GPA) and microscopic polyangitis

22
Q

Accelerated hypertension can be a cause of AKI What can this show on histology of the kidney?

A

• Fibrinoid necrosis is seen in arterioles and in glomerular tufts and multiple cortical petechial haemorrhages

23
Q

What is the commonest cause of renal failure in children under 5years old?

A

E.Coli 0157

24
Q

What can E.coli 0157 cause that damages the kidneys?

A

It can release a verotoxinnthat causes haemolytic uuraemic syndrome

25
Q

What is the classic triad of haemolytic uraemic syndrome?

A

Kidney failure - uraemia, thrombocytopenia (low platelets) and haemolytic anaemia

26
Q

If the patient presents with haemapreoteinuri and haemoptysis What should you test for? What do you think is the cause?

A

Test for ANCA (c-ANCA PR3) - wegener’s granulomatosis and Anti-GBM anitbody - Goodpasture’s syndrome

27
Q

What is post renal failure due to?

A

Obstruction lead to back pressure in the kidneys causing oliguria

28
Q

What is the treatment of post renal causing acute kidney failure?

A

Catheterisation or Nephrostomy

29
Q

What is it important to check in acute kidney injury?

A

Check the blood pressure - patinet could require fluid and also check ureas and electrolytes

30
Q

What are examples of things that can cause obstruction in post-renal failure?

A

Stones, tumours, strinctures

31
Q

Hyperkalaemia Fluid Overload (Pulmonary oedema) Severe Acidosis Uraemic pericardial effusion Severe Uraemia These are life threatening complications of acute kidney injury What pH is the severe acidosis? What level is the uraemia?

A

Hyperkalaemia Fluid Overload (Pulmonary oedema) Severe Acidosis (pH 40)

32
Q

What is the hyperkalaemia associated with? What concentration of potassium is life threatening?

A

It is associated with cardiac arrythmias which can lea to cardiac arrest Potassium - >6.5mmol/l

33
Q

How is the hyperkalaemia seen?

A

Seen on ECG as tall tented Twaves Muscle weakness

34
Q

What is the medical treatment for hyperkalaemia?

A

To protect myocardium from arrythmias 10%, 10ml calcium gluconate IV over 2minutes To move potassium back into the cell Give 10 units of actrapid insulin with 50mls50% dextrose Nebulised salbutamol (10mg)

35
Q

The life threatening effects of acute kidney failure require treatment What are the life threatening effects again?

A

Hyperkalaemia Fluid overload (pulmonary oedema) Severe acidosis (less than 7.15) Uraemic pericardial effusion Severe uraemia - greater than 40

36
Q

What is the treatment for the life threatening effects f AKI?

A

Give the patinet haemodialysis

37
Q

Mortality AKI alone 10-30% AKI with one other organ dysfunction 30-50% AKI as part of multiorgan failure 70-90% What are the recovery outcomes for acute kidney injury?

A

Recovery 10-15% do not recover 5-10% recover but have progresssive CKD The rest recover

38
Q

When carrying out an ultrasound in acute kidney injury, this may help determine whether it is an exacerbated unnoticed CKD or actually AKI What would you see on US?

A

o Suspect chronic disease if patients have small kidneys (<9cm) on USS – but the only definite sign of chronic disease is previous blood results showing high creatinine/low GFR

39
Q

There is a KDIGO (kidney Disease - Improving Global Outcomes) of acute kidney injuery What is the serum creatinine criteria in stage1?

A

Increase >26µmol/L or Increase > 1.5-1.9 x reference Cr

40
Q

What is the urine output in stage 1 KDIGO classification?

A

Les sthan 0.5 ml/kg/hr for >6hours

41
Q

What is the serum creatinine and urine ouput criteria for stage 2 on the KDIGO classifcation?

A

Increase > 2 to 2.9 x reference SCr 12 hrs

42
Q

What is the serum creatinine and the urine output for stage 3 classification?

A

Increase > 3 x reference SCr or increase to > 354µmol/L or need for RRT 24hrs or 12 hrs for anuria

43
Q

Which of these is AKI 3 by KDIGO? A – Biochemical kidney injury disappearing after rehydration B – creatinine of 354 C – anuria for 6 hours D – eGFR 60 E – creatinine 2.5 times base line F – urine output 0.5mL/kg/hr for 6 hours G– creatinine increased by 27µmol

A

B - Creatinine of 354 micromoles or greater Urine output - less than 0.3ml/kg/hr for 24 hours or anuric for 12 hours

Year 2(B7) - Renal (51 decks)

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