Flashcards in Acute Kidney Injury Deck (19):
What is acute kidney injury?
Abrupt decline in renal function leading to increase nitrogenous waste products normally excreted by the kidney
What are the CFx of AKI?
-Azotemia (increased BUN, Cr)
-Abnormal urine volume (anuria, oliguria, polyuria)
What are the most common causes of AKI in hospitalised patients?
Features suggesting pre-renal aetiology of AKI?
-Clinical: dec BP, inc HR, orthostatis hTN and BP changes
-Increased [urea] >> [Cr]
-Urine osmolality >500mOsm/kg
Features suggesting renal aetiology of AKI?
-Appropriate clinical contest
-Urinalysis +ve for casts
Features suggestive of post renal aetiology?
-Known solitary kidney
-Recent peritoneal surgery
Which drugs are involved in pre-renal azotemia?
Ix in AKI?
-Blood: FBE, UEC, CMP
-Urine: volume, MCS, urinalysis
-Foley catheter: r/o obstruction
-Fluid challenge (r/o most prerenal causes)
-Imaging: Renal Tract U/S
What are the indications for biopsy in AKI work up?
-Diagnosis not certain
-Prerenal azotemia or ATN unlikely
-Oliguria persists >4wk
Preliminary management of AKI?
-correct pre renal factors: optimise volume status and CV performance -> fluids that will stay in plasma (NS/alb/blood)
-address reversible renal causes: withhold nephrotoxins, treat infection, optimise electrolytes
-consider obstruction: structural (stones, strictures) vs functional (neuropathy)
-Rx: Foley / indwelling bladder catheter / stenting
How is fluid overload managed in AKI?
-High dose loop diuretics
Management of complications in AKI?
-Manage fluid overload
-Renal dosing of meds
What are the types of complications of renal failure presentation?
Why does volume overload occur in renal failure?
Due to increase in total body Na+ content
What are the signs of renal failure volume overload?
-Pulmonary / peripheral oedema
Pattern of electrolyte abnormalities in renal failure?
HIGH: K+, PO4^3-, Ca2+ (rare), uric acid
LOW: Na+, Ca2+, HCO3-
In what setting would Ca2+ be elevated in renal failure?
-Recovery phase after rhabdomyolysis induced AKI
-Hypercalcemia contributes to renal failure: sarcoidosis, MM
What are the complications of AKI?
-CNS: dec LOC, stupor, seizure
-CVS: cardiomyopathy, CHF, arrhythmia, pericarditis, atherosclerosis
-GI: PUD, gastroduodenitis, AVM
-HAEM: anemia, bleeding tendency, infections
-ENDO: decreased testosterone, estrogen, progesterone; increased: FHS, LH
-METABOLIC: renal osteodystrophy, hypertriglyceridemia, insulin resistance
-DERM: pruritus, ecchymosis, haematoma, calciphylaxis