Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CP3 @ UoN - Medicine & Surgery > Acute Renal Failure (ARF) and Kidney Injury > Flashcards

Acute Renal Failure (ARF) and Kidney Injury Flashcards

1
Q

What is Acute Kidney Injury/Renal Failure?

A

A sudden deterioration in kidney function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the defining clinical features of AKI?

A

ANY OF:
Urine output <0.5ml/kg/hr for 6 hours
>50% rise in creatinine over 7 days
>26umol rise in creatinine over 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the AKIN criteria?

A

Classifies AKI by serum creatinine/urine output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the changes in Stage 1 AKI?

A

Serum Creatinine - 150-200% increase OR 25umol/l increase in 48h
Urine Output - <0.5ml/kg/hr for 6 h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the changes in Stage 2 AKI?

A

Serum Creatinine - 200-300% increase

Urine Output - <0.5ml/kg/hr for 12 h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the changes in Stage 3 AKI?

A

Serum Creatinine - >300% increase OR >350umol/L w/ acute rise of >45umol in 48 h
Urine Output - <0.3ml/kg/hr for 24h OR anuria for 12h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In what patients is AKI more common?

A

Men
Elderly
Pre-existing CKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does AKI present?

A

Often asymptomatic w/ oliguria (<0.5ml/kg/h)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the potential complications of AKI?

A

Uraemia (vomiting, pruritis, pericarditis, encephalitis)
Hyperkalaemia
Pulmonary oedema due to fluid overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the common pre-renal causes of AKI?

A

SHOCK - hypovolemic, cardiogenic, distributive

RENOVASCULAR OBSTRUCTION - embolus, aortic dissection, renal artery stenosis/thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the common post-renal causes of AKI?

A

Ureteric obstruction

Bladder outlet obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the common intrinsic (renal) causes of AKI?

A 
Acute tubular necrosis (85%)
Interstitial nephritis (10%)
Glomerular disease (5%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the pharmaceutical causes of ATN?

A

Aminoglycosides
Cephalosporins
Contrast material
NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the toxic causes of ATN?

A

Heavy metal poisoning
Myoglobinuria
Haemolytic Uraemic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe interstitial nephritis

A

Commonly caused by drugs (a/b)
Damage to tubular cells + interstitium
Managed w/ withdrawal of drugs & oral steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is acute tubular necrosis?

A

Prolonged ischaemia leads to necrosis of cells lining renal tubules

  • tubular membranes become porous
  • tubules blocked by necrosed cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the urine abnormalities in initial pre-renal AKI?

A

Urine osmolality high (>500mosmol/kg)

Urine Na low

18
Q

What are the urine abnormalities in ATN?

A 
Urine isotonic (<400mosmol/kg)
Urine Na high
19
Q

What is myoglobinuria?

A

Excess myoglobin in the urine

  • very dark urine
  • can damage tubules
20
Q

What cause myoglobinuria?

A

Rhabdomyolysis

-muscle breakdown from trauma, strenuous exercise or medications

21
Q

What is Haemolytic Uraemic Syndrome?

A

Syndrome of

  • thrombocytopenia
  • haemolysis
  • ATN
22
Q

What causes HUS?

A

Post diarrhoeal in children (E.coli O157)

Post URTI in adults

23
Q

What are the management options for HUS?

A

Supportive

Dialysis

24
Q

What is the prognosis of HUS?

A

Children - recover w/i wks

Adults - poor

25
Q

What is the general approach to a patient w/ oliguria, or other signs of decreased renal function?

A

Is it AKI/CKD?
-CKD if comorbidities/long duration of sx
If AKI is it pre/intrinsic/post
-pre-renal (?shock ?renal bruits ?vasc pathology)
-intrinsic (drug hx ?recent infec ?blood/protein in urine)
-post-renal (abdo USS ?prostate)

26
Q

What are the appropriate initial investigations in decreased renal function?

A 
Obs - hypo if pre-renal, hyper if CKD
Exam - palpable bladder if obstruction
Bloods - FBC, U&amp;Es, bicarb, phos, CRP, clotting, CK
Nephritic screen
ABG
Urine dip &amp; MCS
ECG/echo
Renal USS +/- biopsy
Non-contrast CT
27
Q

What investigations comprise a nephritic screen?

A 
ANCA &amp; anti-GBM (RPGN)
ANA, dsDNA &amp; complement (SLE)
Immunoglobulins, serum electrophoresis (myeloma)
Rheumatoid factor (RAGN)
Hep B/C (MCGN)
ASO (post-strep)
28
Q

What are the immediate management options for an AKI?

A 
A-E resus
Halt damaging drugs (ACEIs, NSAIDs)
Restrict K+ intake
Pre-renal --> treat shock
Post-renal --> refer to urology
Renal --> fluid balance, CVP measurement
Management of complications
Acute dialysis
29
Q

What are the potential life threatening complications of AKI?

A 
Refractory hyperkalaemia
Pulmonary oedema
Acidosis
Uraemic pericarditis/encephalopathy
Complete anuria
Drug OD
30
Q

Describe the natural history of an improving AKI

A

1 wk oliguria –> improving AKI –> 1wk polyuria –> normal kidney function (wk3)

31
Q

What are the common electrolyte abnormalities in AKI?

A 
Rapidly progressive uraemia
Hyperkalaemia
Hypernatremia (unless pre-renal)
Metabolic acidosis
Hypocalcaemia/hypophosphatemia (CKD)
32
Q

What are the sx of rapidly progressive uraemia?

A 
Anorexia
Vomiting
Pruritis
Encephalopathy (confusion, drowsiness, fitting)
Haemorrhagic episodes
33
Q

What are the causes of hyperkalaemia?

A 
Pseudohyperkalaemia
AKI/CKD
Drugs
Acidosis
Addison's
Tumour-lysis syndrome
Burns
34
Q

What are the causes of pseudohyperkalaemia?

A

Haemolysis
Incorrect order of blood draw
Sample taken from drip arm

35
Q

What are the drug causes of hyperkalaemia?

A

Supplements
K sparing diuretics
ACEIs
NSAIDs

36
Q

What are the signs of hyperkalaemia on ECG?

A

Tall peaked T-waves
Widened QRS complex
Flattened P waves/prolonged PR

37
Q

What are the complications of untreated hyperkalaemia?

A

Ventricular fibrillation

Ventricular tachycardia

38
Q

What are the three management aims when treating hyperkalaemia?

A 
Stabilise myocardium (calcium gluconate)
Drive K intracellularly/buy time (insulin &amp; dextrose/SABA)
Remove K from body
39
Q

When should emergency management of hyperkalaemia be initiated?

A

If K+ >6.5mmol/L or ECG changes

40
Q

What is the emergency management of hyperkalaemia?

A 
Continuous ECG monitoring
10ml of 10% calcium gluconate IV
   -repeat at 5mins, max 3 doses
125mg 20% dex + 10U actrapid, large vv over 30mins
   -50ml of 50% glucose w/ 10U actrapid
Sodium bicarb (if pH <7.2)
Consider 10mg Salbutamol neb
41
Q

What long term management options are available for hyperkalaemia?

A 
Calcium resonium (orally/rectally)
Treat underlying cause

CP3 @ UoN - Medicine & Surgery (135 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions