Acute Kidney Injury Flashcards Preview

Renal, Urinary and Bladder > Acute Kidney Injury > Flashcards

Flashcards in Acute Kidney Injury Deck (19):
1

What is acute kidney injury?

Abrupt decline in renal function leading to increase nitrogenous waste products normally excreted by the kidney

2

What are the CFx of AKI?

-Azotemia (increased BUN, Cr)
-Abnormal urine volume (anuria, oliguria, polyuria)

3

What are the most common causes of AKI in hospitalised patients?

-Prerenal azotemia
-ATN

4

Features suggesting pre-renal aetiology of AKI?

-Clinical: dec BP, inc HR, orthostatis hTN and BP changes
-Increased [urea] >> [Cr]
-Urine osmolality >500mOsm/kg
-Na+ excretion

5

Features suggesting renal aetiology of AKI?

-Appropriate clinical contest
-Urinalysis +ve for casts

6

Features suggestive of post renal aetiology?

-Known solitary kidney
-Older man
-Recent peritoneal surgery
-Anuria
-Palpable bladder
-U/S: hydronephrosis

7

Which drugs are involved in pre-renal azotemia?

-Anti-hypertensives
-Diuretics
-NSAIDs
-ACEi/ARBs

8

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

9

What are the indications for biopsy in AKI work up?

-Diagnosis not certain
-Prerenal azotemia or ATN unlikely
-Oliguria persists >4wk

10

Preliminary management of AKI?

PRE-RENAL:
-correct pre renal factors: optimise volume status and CV performance -> fluids that will stay in plasma (NS/alb/blood)
-hold ACEi/ARB
RENAL:
-address reversible renal causes: withhold nephrotoxins, treat infection, optimise electrolytes
POST RENAL:
-consider obstruction: structural (stones, strictures) vs functional (neuropathy)
-Rx: Foley / indwelling bladder catheter / stenting

11

How is fluid overload managed in AKI?

-NaCl restriction
-High dose loop diuretics

12

Management of complications in AKI?

-Manage fluid overload
-Correct hyperkalemia
-Renal dosing of meds
-Dialysis

13

What are the types of complications of renal failure presentation?

-Volume overload
-Electrolyte abnormalities
-Uremic syndrome

14

Why does volume overload occur in renal failure?

Due to increase in total body Na+ content

15

What are the signs of renal failure volume overload?

-Weight gain
-HTN
-Pulmonary / peripheral oedema

16

Pattern of electrolyte abnormalities in renal failure?

HIGH: K+, PO4^3-, Ca2+ (rare), uric acid
LOW: Na+, Ca2+, HCO3-

17

In what setting would Ca2+ be elevated in renal failure?

-Recovery phase after rhabdomyolysis induced AKI
-Hypercalcemia contributes to renal failure: sarcoidosis, MM

18

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

19

What is renal osteodystrophy?

Secondary increased PTH due to decreased Ca2+, high PO4(3-) and low active Vit D.