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Z Year3 Urology > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

(90 cards)

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1
Q

What is AKI?

A

sudden rapid reduction in eGFR with or without oliguria/anuria – couple weeks

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2
Q

What is oliguria?

A

reduction in urine output

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3
Q

What is anuria?

A

complete cessation of urine production

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4
Q

What is the KDIGO criteria based on?

A

serum Cr or urine output

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5
Q

What are serum Cr levels for Stage 1 AKI?

A
  1. Based on: Baseline x1.5 more than baseline
    OR
  2. ≥26 umol/L (≥0.3 mg/dL) increase in baseline
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6
Q

What are urine output levels for Stage 1 AKI?

A

<0.5mL/kg/h for 6-12h

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7
Q

What are serum Cr levels for stage 2 AKI?

A

Baseline x2 -2.9

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8
Q

What are urine output levels for stage 2 AKI?

A

<0.5mL/kg/h for ≥12h

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9
Q

What are serum Cr levels for stage 3 AKI?

A
  1. Baseline x3 or over

2. ≥354 umol/L (≥4 mg/dL) increase

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10
Q

What are urine output levels for stage 3 AKI?

A
  1. 0.3mL/kg/h for 24h
  2. Anuria for 12h
  3. Or if patient on Renal replacement therapy (dialysis)
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11
Q

Which parameter do you use to determine stage if they are conflicting?

A
  • You will use the parameter that gives the worst disease state
  • (i.e.: if a patient has peed <0.5mL/lg/h in the last 6 hours but has an increase in serum creatinine 2.5 times their baseline, then you will stage their AKI as stage 2 rather than 1)
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12
Q

What are the possible complications for an AKI?

A
  1. Fluid overload
  2. Uraemia
  3. Metabolic acidosis
  4. Hyperkalaemia
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13
Q

What are the symptoms of fluid overload?

A

pulmonary oedema

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14
Q

What is the management of fluid overload?

A
  1. IV furosemide/ GTN infusion

2. haemodialysis if refractory

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15
Q

What are symptoms of uraemia?

A
  1. Uraemic encephalitis (lethargy, confusion)

2. uraemic pericarditis

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16
Q

What is the management of uraemia if symptomatic?

A

haemodyalsis

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17
Q

What are symptoms of metabolic acidosis?

A
  1. Confusion
  2. tachycardia
  3. Kussmaul’s breathing
  4. N&V
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18
Q

What is the management for metabolic acidosis?

A
  1. IV/PO sodium bicarbonate

2. dialysis if refractory

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19
Q

How do you asses fluid overload?

A
  1. JVP
  2. pitting oedema
  3. crackles on chest
  4. capillary refill
  5. BP
  6. HR
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20
Q

What are symptoms of hyperkalameia?

A
  1. Asymptomatic
  2. Arrhythmias
  3. Muscle weakness
  4. Cramps
  5. Parasthesias
  6. Hypotension
  7. Bradycardia
  8. Cardiac arrest
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21
Q

What are K levels for mild hyperkalaemia?

A

5.5-6

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22
Q

What are K levels for moderate hyperkalaemia?

A

6.1-6.5

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23
Q

What are K levels for severe hyperkalaemia?

A

K>6.5 OR Any K with ECG changes and symptomatic

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24
Q

How do you manage hyperkalamia?

A
  1. Cardiac monitor
  2. Calcium gluconate: 10% 30mls IV
  3. 10U soluble insulin
  4. 50mls of 50% glucose
  5. Also may benefit from:
    - Salbutamol nebulisers
    - IV furosemide
    - IV sodium bicarb (if acidosis)
  6. Stop offending cause, continuous monitoring of K+
  7. If refractory, start haemodyalisis
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25
What does of calcium gluconate is given for hyperkalamia?
10% 30mls IV
26
Why do you give calcium gluconate in hyperkalamia?
protects the heart
27
What dose of soluble insulin do you give in hyperkalamia?
10U
28
What dose of glucose do you give in hyperkalamia?
50mls of 50% glucose
29
Why do you give soluble insulin in hyperkalamia?
drives excess K+ into cells and out of blood
30
Why do you give glucose in hyperkalamia?
avoids hypoglycaemia
31
What are ECG changes in hyperkalamia?
1. Peaked T wave 2. Wide PR interval 3. Wide QRS duration 4. Loss of P wave 5. Sinusodial wave 6. Bradycardia
32
When do you treat hyperkalamia?
only if severe
33
What investigations are done for AKI?
1. Fluid assessment 2. ABG/VBG, potassium & bicarb – gets quick K 3. Bloods 4. Hepatitis/HIV screen, vasculitic screen, myeloma screen, anti-GBM… Sepsis screen (if septic) 5. KUB 6. ECG 7. Good medication history
34
How do you do a fluid assessment?
check membranes, cap refill
35
What bloods are ordered for AKI?
1. FBC 2. U&Es 3. CRP 4. LFTs 5. CK 6. clotting
36
How is AKI managed?
1. ABCDE approach 2. Find and treat cause 3. STOP ANY NEPHROTOXIC DRUGS 4. Fluid management 5. Treat complications 6. Dialysis if necessary
37
How would you treat the hypovolaemia in AKI?
IV fluids
38
How would you treat the hypervoleamia in AKI?
Offloading with IV diuretics or dialysis
39
What can you stop asap?
IV not oral as could be allergy etc
40
What are the categories causes of AKI?
1. Renal: problems with kidney tissue 2. Pre-renal: problems with blood supply 3. Post-renal: problems with urine outflow
41
What is pre-renal AKI caused by?
caused by decreased kidney perfusion
42
What are 3 categories for pre-renal AKI?
1. Hypovolaemia 2. Low volume 3. Vascular insult
43
What can lead to the hypovolaemia (excessive fluid losses) in pre-renal AKI?
1. Acute hemorrhage 2. GI losses 3. Diuresis 4. Burns 5. Third-spacing: sepsis and acute pancreatitis
44
What can lead to the low volume (low effective circulating volume) in pre-renal AKI?
1. Heart failure (Cardiorenal Syndrome) | 2. Liver failure (Hepatorenal Syndrome)
45
What can lead to the vascular insult (damage to arteries/arterioles supplying the kidneys) in pre-renal AKI?
1. ACEi/ARBs 2. NSAIDs 3. Contrast 4. Renal artery stenosis
46
What are signs of hypovolaemia?
1. tachycardia 2. hypotension reduced skin turgor 3. cool extremities
47
What is cardiorenal syndrome?
AKI + signs of HF
48
What is hepatorenal syndrome?
AKI + signs of decompensated liver disease
49
What is post-renal AKI caused by?
obstruction of urine outflow
50
What are the 3 categories of post-renal AKI causes?
1. Luminal 2. Mural 3. Extramural
51
What can cause luminal post renal AKI?
kidney stones
52
What are symptoms of kindey stones?
- Urethra: Pain, Anuria | - Ureters: Renal colic
53
What can cause mural post-renal AKI?
1. Cancers of renal tract | 2. Strictures
54
What can cause extramural post-renal AKI?
1. Abdominal/ pelvic cancers | 2. BPH
55
What is renal colic?
intermittent loin-to-groin excruciating pain
56
What is renal AKI caused by?
intrinsic kidney damage
57
What are different categories for causes of renal AKI?
1. Tubular 2. Interstitial 3. Vascular 4. Glomerular
58
What is the tubular cause of renal AKI?
acute tubular necrosis (ATN)
59
What are two causes of ATN?
1. Ischaemic | 2. Toxic
60
How does ischaemic ATN happen?
1. Damage to tubular cells 2º to prolonged and severe ischemia 2. Decreased blood flow (2º to shock, HF, renal artery stenosis, excessive GI fluid loss…)
61
How does toxic ATN happen?
direct effects of nephrotoxins on tubular cells (endogenous and exogenous)
62
What endogenous toxins can cause ATN and AKI?
1. Myoglobulin 2. Uric acid (tumor lysis syndrome) 3. monoclonal light chains (multiple myeloma)
63
What exogenous toxins can cause ATN and AKI?
1. Aminoglycosides 2. cisplatin 3. NSAIDs 4. Heavy metals 5. radiocontrast agent
64
How do you diagnose ATN?
``` Granular muddy brown casts on urinalysis (MSU) ```
65
What is treatment for ATN?
1. Reversible: Recovery within 21 days approx. | 2. After initial insult causing ATN patients develop profound diuresis
66
How do you manage this profound diuresis?
1. strict urine input and output monitoring | 2. IV fluids to keep up with losses
67
What is the interstitial cause of renal AKI?
Acute interstital necrosis (AIN)
68
What is AIN?
Immune-mediated damage of renal interstitium
69
What sort of a reaction is AIN?
driven by a Type 4 hypersensitivity reaction, usually to medication
70
What medications can cause AIN?
1. NSAIDs 2. Thiazide diuretics 3. Penicillin
71
What is recovery like for AIN?
within weeks of removing offending agent
72
How does AIN present?
1. rash 2. fever 3. arthralgia 4. eosinophilia (aka. Signs & Sx of an allergic reaction)
73
What can you see on urinalysis in AIN?
White cell casts | on urinalysis
74
What are two causes of vascular renal AKI?
HUS and TTP
75
What is HUS?
haemolyic uraemia syndrome
76
What is TTP?
Thrombotic | Thrombocytopenia Purpura
77
What are symptoms of HUS?
1. Haemolytic anaemia 2. AKI 3. Thrombocytopenia 5. Jaundice 6. Schistcytes 7. Dark urine
78
What are neurological symptoms in TTP?
1. Headaches 2. confusion 3. Seizures 4. partial paralysis 5. speech abnormalities 6. mental changes
79
What are signs of anaemia?
1. weakness 2. fatigue 3. paleness 4. SOBOE
80
What are signs of thrombocytopenia?
1. Petechiae | 2. heavy bleeding
81
What is TTP?
HUS symptoms with fever and neurological symptoms
82
What is the patho of vascular renal AKI?
damage to renal capillaries leading to formation of microthrombi
83
What causes HUS?
* Most common in children, 2º to EHEC infection | * Presents with bloody diarrhoea
84
What is management of HUS?
Abx
85
What is EHEC?
Entero-haemorhagic Eschicheria Ecolis (release of Shiga toxin)
86
What is TTP caused by?
1. ADAMTS 13 deficiency (both autoimmune or congenital) | 2. Enzyme responsible for vWF breakdown
87
What is the management of TTP?
1. Plasmapherisis | 2. Rituximab
88
What is the glomerular cause of renal AKI?
glomerulonephritis
89
What is glomerulonephritis?
1. Damage to glomerulus 2. Inflammation of glomerular capillaries and glomerular basement membrane 3. Usually immune-mediated
90
What are the two presentations of glomerulonephritis?
1. Nephrotic | 2. Nephritic

Z Year3 Urology (18 decks)

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