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Nephrology > AKI > Flashcards

AKI Flashcards

1
Q

Can you use eGFR to describe AKI?

A

No! eGFR formula assumes creatinine in steady state, not valid if changing. eGFR is not safe to use in drug dosing in AKI

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2
Q

Which two measurements are key to assessing AKIs?

A

Serum creatinine and urine output

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3
Q

How can causes of AKIs be divided?

A

Intrinsic, pre-renal, post-renal

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4
Q

Which category of cause is responsible for all AKIs?

A

Pre-renal

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5
Q

Name three examples of intrinsic causes of AKIs

A
  1. Acute tubular injury- rhabdo, nephrotoxins, haemoglobinuria
  2. Tubulointerstitial injury
  3. Glomerulonephritis
  4. Myeloma
  5. Vasculitis
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6
Q

Name three examples of nephrotoxins

A

Iodinated contrast, NSAIDs, gentamicin

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7
Q

Name three examples of pre-renal causes of AKIs

A
  1. Sepsis
  2. Hypovolaemia
  3. Hepatorenal syndrome
  4. Cardiac failure
  5. Hypotension
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8
Q

Name three causes of hypovolaemia

A
  1. Haemorrhage
  2. Burns
  3. Vomiting/diarrhoea
  4. Diuretics
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9
Q

Which three antibiotics should you be wary of in AKIs?

A

Trimethoprim, nitrofurantoin, gentamicin

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10
Q

How does trimethoprim affect the kidney?

A

Increases creatinine

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11
Q

Why should you be cautious with nitrofurantoin when there is an AKI?

A

Not excreted in urine if creatinine clearance <30 therefore inadequate urine concentration to treat UTI and risk of toxicity

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12
Q

Name 5 clinical assessments that can be conducted to determine whether patient is hypovolaemia, euvolaemic, or hypervolaemic

A
  1. Oedema
  2. JVP
  3. Mucous membranes
  4. Skin turgor
  5. Chest auscultation
  6. Urine output
  7. Weight
  8. BP
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13
Q

Name four investigations for AKIs

A
  1. Urinalysis- blood/protein
  2. Bicarbonate
  3. Urine protein:creatinine ratio (uPCR)
  4. Glomerulonephritis screen
  5. Renal USS (within 24 hr unless clear signs of improvement)
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14
Q

Name four components of the glomerulonephritis screen

A
  1. ANCA (MPO/PR3)
  2. ANA
  3. Anti-GBP
  4. RF
  5. Myeloma screen
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15
Q

Name three post-renal causes of AKI

A
  1. Kidney stones
  2. BPH
  3. Tumours
  4. Retroperitoneal fibrosis
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16
Q

At what kidney failure stage should you refer to renal?

A

Stage III

17
Q

What are ECG features of hyperkalaemia?

A

Hypertented T waves, absent P waves, increased PR interval, broad QRS, BBB

18
Q

How to stage AKI?

A

1-3, compare current Cr to baseline, if 1.5-2x greater then stage 1, if 2-3x greater then stage 3, if >3x then stage 3. Note different staging system to CKD

19
Q

What are clinical signs (not symptoms) of CKD?

A

Uraemia, anaemia, vit D deficiency, K+, acidosis

20
Q

What is the management of CKDs?

A

EPO, fluid resus, ACEi, dietary advice

21
Q

What are the five indications for commencement of dialysis?

A

AEIOU: acidosis, electrolyte, ingestion, overload (HF), uraemia

22
Q

What are three ways of defining an AKI?

A
  1. increase in SCr by >0.3 mg/dl within 48 hr
  2. increase in SCr to >1.5 x baseline
  3. Urine volume <0.5 ml/kg/hr for 6 hr
23
Q

What are the stages of AKI?

A

1-3 stage

  1. 1.5-1.9 baseline SCr
  2. 2-2.9
  3. > 3
24
Q

Why is eGFR not used in AKIs?

A

serum creatine needs to be in steady state ~ HbA1C in diabetes

25
Q

What are the pre-renal causes of AKI?

A
  1. volume depletion- vomiting, diarrhoea, diuretics, burns, haemorrhage
  2. Cardiac pump failure
  3. Sepsis
  4. Medications
  5. Hepatorenal syndrome (rare)
26
Q

What are the intrinsic causes of renal AKI based on site?

A

glomerulus- glomerulonephritis

tubules- acute tubular necrosis, rhabdo

renal vessels- renal artery stenosis, occlusion, renal vein thrombosis

27
Q

Which symptoms are associated with intrinsic causes of AKI?

A

rashes, painful eye (ANCA), paresthesia, foot drop, frank haematuria, swelling

28
Q

Investigations for AKI?

A 
U+Es
urine dip 
ABG/VBG 
Renal tract ultrasound
Glomerulonephritis screen
Myeloma screen
Renal biopsy
29
Q

What are the complications of AKI?

A

electrolyte disturbance
fluid overload
metabolic acidosis
uraemic

30
Q

What is the management of AKI?

A 
correct hypovolaemia
treat acute complications (hyperkalaemia, acidosis)
r/v medications 
Optimise cardiac function 
Monitor fluid output
Search for infections
31
Q

How can you assess volume status?

A 
Pulse/BP/SpO2
Urine output
Mucous membranes
Weight
Peripheral oedema/JVP
Loss of skin turgor
32
Q

How can you distinguish AKI from CKD if patient has never undergone U+E blood testing?

A

renal size on US- CKD nephrons will appear smaller and cystic
anaemia- anaemia of chronic disease
hyperparathyroidism- association with CKD

33
Q

In which condition associated with AKI can you develop a petechial rash?

A

SLE, vasculitis

34
Q

In which condition associated with AKI can you develop a purpuric rash?

A

thrombotic thrombocytopenic purpura, systemic vasculitis, henoch schloenlein purpura

35
Q

Which poisons result in renal replacement therapy?

A 
BLAST it out
Barbiturates
Lithium
Alcohols
Salicylates
Theophyline
36
Q

What level of creatinine kinase would you suspect rhabdomyolisis?

A

very high, 10,000’s

Nephrology (8 decks)

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