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renal > acute kidney injury > Flashcards

acute kidney injury Flashcards

1
Q

what is acute kidney infection?

A

an abrupt (<48hours) reduction in kidney function defined as:

  • an absolute increase in serum creatinine by >26.4 micro mols/l
  • OR increase in creatinine by >50%%
  • OR a reduction in UO <0.5mL/kg/hr for >6 consecutive hours
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2
Q

what is the staging for AKI?

A

KDIGO

-either serum Cr criteria or urine output criteria

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3
Q

what are risk factors for AKI?

A
  • older age
  • CKD
  • diabetes
  • cardiac failure
  • liver disease
  • PVD
  • previous AKI
  • hypotension
  • hypovoleamia
  • sepsis
  • deteriorating NEW
  • recent contrast
  • exposure to certain meds
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4
Q

what are some pre renal causes of AKI?

A

anything that causes a reduction in the perfusion to the kidneys

Hypovolaemia:

  • haemorrhage
  • volume depletion (e.g. D&V, burns)

Hypotension:

  • cardiogenic shock
  • distributive shock (e.g. sepsis, anaphylaxis)

Renal Hypoperfusion:

  • NSAIDs/ COX-2
  • ACEI/ ARBs
  • hepatorenal syndrome
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5
Q

what may cause hypovalaemia leading to pre renal AKI?

A
  • haemorrage

- volume depletion (e.g. D&V, burns)

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6
Q

what may cause hypotension leading to pre renal cause of AKI?

A
  • cardiogenic shock

- distributive shock (e.g. sepsis, anaphylaxis)

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7
Q

what may cause renal hypoperfusion leading to a pre renal cause of AKI?

A
  • NSAIDs/ COX-2
  • ACEI/ ARBs
  • hepatorenal syndrome
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8
Q

how can you define a pre renal AKI?

A

-reversible volume depletion leading to oliguria and increase in creatinine

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9
Q

what does untreated pre renal AKI lead to?

A

acute tubular necrosis

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10
Q

what is acute tubular necrosis?

A
  • the commonest form of AKI in hospitals due to a combination of factors leading to decreased renal perfusion
  • commonest causes include sepsis, severe dehydration, rhabdomyolysis and drug toxicity
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11
Q

what is the treatment for pre renal AKI?

A

Assess for hydration:

  • clinical observations (BP, HR, UO)
  • JVP, capillary refill time, oedema
  • pulmonary oedema

Fluid challenge for hypovolaemia:

  • Crystalloid (0.9% NaCl) or Colloid (Gelofusion)
  • do not use 5% dextrose!!
  • give bolus of fluid then reassess and repeat if necessary (give max 1L)
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12
Q

what causes renal AKI?

A

Diseases causing inflammation or damage to cells causing AKI

Vascular:

  • vasculitis
  • renovascular disease

Glomerular:
-glomerulonephritis

Interstitial Nephritis:

  • drugs
  • infection (TB)
  • systemic (sarcoidosis)

Tubular Injury:

  • Ischaemia
  • drugs (gentamycin)
  • contrast
  • rhabdomyolysis
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13
Q

what are vascular causes of renal AKI?

A
  • vasculitis

- renovascular disease

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14
Q

what are glomerular causes of renal AKI?

A

-glomerulonephritis

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15
Q

what are interstitial nephritis causes of renal AKI?

A
  • drugs
  • infection (TB)
  • systemic (sarcoidosis)
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16
Q

what are tubular injury causes of renal AKI?

A
  • ischaemia
  • drugs (gentamycin)
  • contrast
  • rhabdomyolysis
17
Q

what are some signs and symptoms of AKI?

A
  • anorexia
  • weight loss
  • fatigue
  • lethargy
  • nausea + vomiting
  • itch
  • fluid overload (oedema, SOB)

SIGNS:

  • fluid overload (HTN, oedema, pulmonary effusion, pleural effusion, pulmonary oedema)
  • uraemia (itch, pericarditis)
  • oliguria
18
Q

what are the initial investigations for AKI?

A
  • U&Es
  • FBC and coagulation screen
  • urinalysis (haematoproteinuria)
  • USS (incase of obstruction)
  • immunology (ANA, ANCAm GBM)
  • protein electrophoresis and BJP
19
Q

what is the cause of post renal AKI?

A

AKI due to obstruction of urine flow lading to back pressure and thus loss of concentrating ability

  • stones
  • cancers
  • strictures
  • extrinsic pressure
20
Q

what can cause cardiac arrhythmias in AKI?

A

hyperkalaemia

21
Q

what is treatment for hyperkalaemia?

A
  • cardiac monitor and IV access
  • protect myocardium (10mls 10% calcium gluconate for 2/3 mins)
  • Move K+ back into the cell (insulin actrapid 10 units with 50 mls 50% dextrose for 30 mins and nebulised salbutamol for 90 mins)
  • prevent absorption from GI tract using calcium resonium (NOT in an acute setting)
22
Q

what are indications for HD (hemodialysis)?

A
  • hyperkalaemia >7 or >6.5 if patient unresponsive to medical therapy
  • severe acidosis pH <7.15
  • fluid overload
  • urea >40, pericardial rub/effusion
23
Q
A
  1. B
  2. A
  3. C
  4. D
24
Q
A

Furosemide does not- it causes lower potassium

25
Q
A

Calcium gluconate

26
Q
A

elevated creatinine on its own is not an indication

renal (37 decks)

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