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Flashcards in Acute Kidney Injury Deck (16)
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1

What 3 Ix are used to interrogate the cause of AKI?

Fluid stasis

Urine analysis

Ultrasound

2

Outline the pathophysiology of ATN

Ischaemia > Depletion of ATP > Release of ROS > apoptosis > cell desquamation > obstructive casts

3

What are the implications of anuria vs oliguria for the cause of AKI?

Anuria - more likely complete obstruction, major vascular catastropy, severe ATN

Oliguria - less severe

4

How might you differentiate pre-renal and intrinsic causes of AKI?

Osmolarity will be >500 in pre-renal but <350 in intrinsic as its lost its concentrating ability. Similarly the urine salt will be high in intrinsic

 

Look for cast in urine for intrinsic (prerenal urine is normal)

 

 

5

What does STOP stand for as to the causes of AKI?

Sepsis and hypovolaemia

Toxins

Obstructions

Parenchyma disease

6

What are the three phases of ATN?

Initiation - Acute drop in GFR and initial rise in Cr

Maintenance - GFR remains low, Cr and Urea rise significantly

Recovery - Tubular function is restored and Cr drops

7

How is hyperkalaemia treated?

Insulin and glucose

Calcium gluconate (stabilise the heart)

Resonium

Dialysis

8

What are some post renal causes of AKI?

Prostate enlargement

Uteric strictures

Tumours

Surgical disruption

Bilateral caliculi

9

What should be done if AKI occurs?

Remove the offending agent

Meticulous fluid balance - volume overload is bad

Measure urea, creatinine and other electrolytes

Daily weights

10

What is the major difference between haemodialysis and haemofiltration?

Haemodialysis works via osmosis

Haemofiltration works by ultrafiltration

11

What are some prerenal causes of AKI?

Hypovolaemia - Bleeding, GI loss, inappropriate replacement post op, diuretics, 3rd space loss

Cardiogenic - acute fall in CO

Sepsis

Neurogenic 

12

How can intrinsic causes of AKI be subcharacterised?

1. Tubular injury eg ATN

2. Interstitial Injury eg drugs, infection

3. Glomerular injury

4. Vascular disease - eg vasculitis

13

How long does it take to recover from ATN?

2-6 weeks

14

Is anuria always a feature of ATN?

No, urine output can still occur

15

How do you evaluate if a kidney injury is acute or chronic?

Look at pre-existing conditions

Look at previous Cr levels

US of kidneys

16

Outline the diagnostic criteria for AKI

Stage I - Creatinine increase by 25umol/L or 150-200%

- Urine output <0.5ml/kg/hour for > 6hours

 

Stage II - Creatinine increase 200 - 300% from baseline

- Urine output <0.5ml/kg/hour > 12 hours

 

Stage III - Creatinine increase >300% or >350umol/L after an increase of 50umol/L

- Urine output <0.3ml/kg/hour for > 24 hours or anuria for > 12hours