Acute Kidney Injury Flashcards Preview

3/ REN > Acute Kidney Injury > Flashcards

Flashcards in Acute Kidney Injury Deck (19)
Loading flashcards...
1
Q

What is acute kidney injury?

A

a rapid (hours to days) decline in kidney function

2
Q

What are the stages of AKI?

A

Stage 1, stage 2, stage 3

3
Q

Who is at risk of AKI?

A
older age
diabetes mellitus
hypertension
heart disease
liver disease
chronic kidney disease
medication
4
Q

What medications can cause AKI?

A
diuretics
ACEi/ARB
NSAID
gentamicin
vancomycin
chemotherapy
5
Q

What can the cause of AKI be classified into?

A
Pre-renal = perfusion failure
Renal = intrinsic disease of the kidney
Post-renal = obstruction of the urinary system
6
Q

Give some pre-renal causes of AKI?

What are these made worse by?

A
hypotension
hypovolaemia
renal artery occlusion 
made worse by:
- RAAS blockade
- NSAIDs
- antihypertensives
- diuretics
7
Q

What is the renal autoregulatory range?

Why is this important?

A

90-200mmHg
If there is drop in blood pressure or blood volume renal perfusion and urine production will be maintained. But if drop is outside of autoregulatory range then perfusion and urine prodcuction cannot be maintained

8
Q

What are the steps of RAAS that can be inhibited with drugs?

A

Inhibit renin = stop conversion of angiotensinogen to angiotensin I
ACE inhibitors = Angiotensin I to angiotensin II
Block efferent arteriolar constriction
block mineralcorticoid receptor antagonist

9
Q

How can drugs lead to pefusion failure?

A

RAS blockade

no compensatory changes in afferent/efferent so autoregulatory ranges change and you lose perfusion

10
Q

What are the histological signs of perfusion failure?

A

acute tubular necrosis

11
Q

What is the treatment of perfusion failure?

A
treat the underlying cause 
- fluid volume replacement 
- blood pressure support (inotropes)
restore arterial patency 
- stop RAS blockade
- stop NSAID
12
Q

What things can cause post renal obstruction?

A

stones
benign prostate
tumours (extrinsic/instrinsic)
fibrosis

13
Q

What is the treatment of excretion?

A

bypass to remove obstruction

  • nephrostomy
  • bladder catheter
  • lithotripsy
  • tumour removal
  • dilating strictures
14
Q

What are the ‘renal’ causes of renal failure?

A
Diseases the damage the 
- tubules
- glomerulus
- interstitium
Systemic diseases
- vasculitis, SLE, myeloma
Infection 
- HIV, endocarditis
Allergic (to antibodies)
- acute interstitial nephritis 
Drug toxicity 
- gentamycin, NSAID, chemotherapy 
Glomerulonephritis
15
Q

What is ANCA associated vasculitis?

A

Anti-neutrophil cytoplasm antibodies

  • airway and renal organs most commonly involved
  • cause life threatening acute or chronic organ damage
16
Q

What do ANCA do?

A

they activate neutrophils

17
Q

What are the histological signs of renal vasculitis?

A

necrotic cells
inflammatory cells
compressed glomerular tuft

18
Q

How inflammatory renal disease? What are the risks/complications of these treatments?

A

Steroids
- diabetes, infection, osteoporosis, skin damage, weight gain
Cyclophosphamide
- infections, malignancy, bone marrow suppression, infertility,
Plasma exchange
- infection, bleeding, risks of central lines
Azathioprine/Mycophenolate
- infection, cancer, liver abnormalities

19
Q

What are the causes of death in AKI?

A
underlying disease
infection
hyperkalaemia
acidosis
pulmonary oedema