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GU > Acute Kidney Injury* > Flashcards

Acute Kidney Injury* Flashcards

1
Q

What is an AKI

A

Abrupt decline in kidney function charecterised by high serum creatinine/urea and low urine output

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2
Q

What are the main 2 charecteristics of AKI

A

Raised serum creatinine (1.5x baseline or >26nmol/L for 2 days)
OR
Urine output <0.5/kg/hr for >6 hours

Low urine output (<0.5ml/kg/hr for >6hrs)

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3
Q

What is the classification system of AKI

A

KDIGO

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4
Q

What is the staging system of AKI

A

RIFLE

  • Risk
  • Injury
  • Failure
  • Loss
  • End stage renal fail
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5
Q

What is the new preffered classification of AKI

A

AKIN

  • Stage 1/2/3
  • the higher the stage the lower the mortality
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6
Q

What can the causes of AKI be distributed into

A 
Pre renal (Hypoperfusion)
Renal (Kidney damage)
Post renal (Obstruction)
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7
Q

What are the pre renal causes of AKI (HYPOPERFUSION)

A

Nausea and vomiting = Hypovolemia
Low CO (CHF, Cardiogenic shock)
Liver fail (Hepatorenal syndrome)
Renal artery blockage/stenosis
Drugs (NSAIDs and ACEi) Decrease GFR

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8
Q

What are the renal causes of AKI (Nephron and Parenchymal damage)

A

Acute tubular necrosis
Toxins (sepsis)
Interstitial damage
Glomerular damage
Renal cell apoptosis by Gentamycin

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9
Q

What are the post renal causes of AKI (Obstruction)

A

Stones
BPH
Drugs (CCB and Anticholinegenic)
Catheter occlusion
Tumours

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10
Q

What is the pathognomonic sign of Acute tubular necrosis

A

Muddy brown casts in urine

-Dead Tubular cells

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11
Q

What are the RF of AKI

A

Age
Comorbidities
Hypovolemia
Nephrotoxic drugs (NSAIDs)

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12
Q

What is the pathology of AKI

A

Decreased blood filtration and urine output
More excretion products at the kidney = AKI

Accumululation of “excreted” substances in the kidney

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13
Q

What are the pathogenic Electrolytesof AKI that are usually excreted with urine

A 
K = hyperkalemia
Urea = hyperuremia
Fluid = oedema
H+ = acidosis
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14
Q

What are the presentations of AKI

A 
Hyperkalemia -> Arrythmia
Hyperuremia -> pruritis and uremic frost
Oedema (Pulmonary and peripheral oedema and hypovolemic shock)
Metabolic Acidosis
Haematuria, Proteinuria, Oliguria and Anuria
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15
Q

What can severe hyperuremia cause

A

Encephalopathy

-HE related due to ammonia

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16
Q

Why are ACE inhibitors CI in AKI

A

Constrict the afferent kidney so greater interstitial pressure by increased substrates

Dcreased perfusion to the glomerulus

17
Q

How may an ECG present in AKI

A 
Tall T
Petite P
Wide QRS
Prolonged PR
Sinusoidal wave
18
Q

How is AKI investigated

A 
KDIGO = Establish cause (PRE/RENAL/POST) 
U+E = Check K/Urea/H+/Creatinine
FBC/CRP = Infection
Renal biopsy = confirm renal cause
USS = confirm post renal cause
19
Q

How can you confirm an intrerenal cause of AKI

A

KDIGO and check serum urea/creatinine and urea outpur

Renal Biopsy

20
Q

How can Post Renal causes of AKI be confirmed

A

KDIGO
U+E
USS

USS

21
Q

How can you manage an AKI

A 
Treat complciations
-Hyperkalemia? calcium gluconate (Cardiac protective)
-Acidosis? Sodium bicarbonate
-Oedema? Diuretics
Treat the cause
Renal replacemnet therapy (RRT)
22
Q

What is Renal Replacemnet Therapy

A

Haemodialysis if AFUKed

  • Acidosis (<7.1)
  • Fluid Oedema
  • Uremic symptoms
  • K Raised
23
Q

What are the uremic symptoms of AKI

A 
Prurits
Uremic frost
Confusion (HE)
Anurea
Palpable bladder
Oliguria
24
Q

What is the best way to establish the type of cause for AKI

A 
Pre = >100 U:C
Renal = <40 U:C
Post = 40-100 U:C
25
Q

What drugs should be stopped in AKI

A

NSAIDs
Aminogylcasides - Gentamycin and amikacin
ACE-I
ARB
Diuretics

26
Q

What drugs should be considered stopping in AKI to prevent worsening

A

Lithium
Digoxin
Metformin

27
Q

What is the normal GFR levels

A

90-120mg/mol

28
Q

What are the normal urine levels

A

2.1-8.5mmol/l

29
Q

What are the signs of hypovolemia

A

Low urine output
Dry mucus membranes and thirst
Dizziness w/N+V
Hypotension
Tachycardia

30
Q

How can heart fail cause AKI

A

Hypoperfusion due to afferent arteriole constriction
-low renal blood flow and low GFR

31
Q

How can Haemorrhage cause AKI

A

Blood lost by haemorrhage - Hypotension
Hypoperfusion of kidney due to hypotension

32
Q

Why should insulin be prescribed for hyperkalemia

A

Sodium proton pump activation
More sodium enters cells activating sodium potassium ATPase
Potassium influx into cells

33
Q

What can be given in adjunct to insulin for cardio protection

A

Calcium Gluconate

GU (10 decks)

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