acute kidney injury Flashcards
what does AKI stand for?
acute kidney injury
what is the definition of acute kidney injury?
increase in serum creatinine:
- by 26.5umol/L or more within 48 hours or
- to >1.5x baseline, which is known or presumed to have occurred within the prior 7 days or
- urine volume <0.5ml/kg/h for 6 hours
how many stages of acute kidney injury are there?
3
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what does the immediately dangerous consequences of AKI depend on?
causes
- acidosis
- electrolyte imbalance
- intoxication toxins
- overload
- uraemic complications
what can the causes of AKI be classified into?
pre-renal
intrinsic (renal)
post-renal
what are the normal functions of the kidneys?
- body fluid homeostasis
- electrolyte homeostasis
- acid/base homeostasis
- regulation of vascular tone
- excretory function
- endocrine function
what are possible bad short term and intermediate/long term complications of AKI?
short term (in hospital): death, dialysis, length of stay
intermediate/long term (post-discharge): death, CKD, dialysis, CKD related CV elements
how does mortality change with the stage of AKI?
mortality increases with stage
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What does renal hypoperfusion cause
Ischemia of renal parenchyma → prolonged ischemia → intrinsic damage → Acute tubular necrosis (ATN)
what are pre-renal causes of AKI?
Renal hypoperfusion:
cardiac failure( reduced CO)
haemorrhage (hypovolaemia)
sepsis (systemic vasodilatation)
vomiting and diarrhoea
How are causes of intrinsic renal causes of AKI categorised?
Location of pathology:
- Vasculature
- Glomerular
- Tubulointerstitial
what are renal causes of AKI?
-
Vasculature
- Large vessel disease:
- Atherosclerosis (Renal artery stenosis)
- Thromboembolic disease (renal artery thrombosis)
- Dissections (aortic)
- Small vessel disease
- Vasculitidies
- Thromboembolic disease
- Microangioplastic haemolytic anaemias
- Malignant hypertension
- Large vessel disease:
-
Glomerular
-
Primary (no systemic disease association)
- glomerulonephritis
- Secondary (systemic disease association)
-
Primary (no systemic disease association)
- Tubulointerstitial
radiocontrast
myeloma
rhabdomyolysis
what are post renal causes of AKI?
Caused by obstructions:
tumours
prostate disease
stones
how is AKI prevented?
by identifying patients who are at risk
(presence of risk event or risk factor)
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what are examples of AKI risk events?
sepsis (pneumonia, cellulitis, UTI)
toxins (x-ray contrast, NSAIDs, gentamicin, herbal medicine)
hypotension
hypovolaemia (haemorrhage, vomiting, diarrhoea)
major surgery
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