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Renal > Acute kidney injury > Flashcards

Acute kidney injury Flashcards

1
Q

What are the broad categories of diagnoses of AKI (Most likely first)?

A
  • Acute tubular necrosis
  • Pre-renal failure
  • Acute-on-chronic kidney disease
  • Urinary tract obstruction
  • Renal inflammatory condition
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2
Q

what features put a patient at increased risk of pre-renal failure or acute tubular necrosis?

A
  • Age and medical co-morbidities. AKI is most common in elderly patients with multiple medical problems
  • Use of medications having adverse renal haemodynamic effects when the circulation is under stress
  • History to suggest the likelihood of intravascular volume depletion
  • Physical examination suggesting intravascular volume depletion
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3
Q

Which drugs typically cause acute interstitial nephritis?

A
  • Antibiotics (including penicillin derivatives)
  • Diuretics
  • NSAIDs
  • Proton pump inhibitors (the most common cause in the UK)
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4
Q

What is the tonicity of 5% dextrose?

A

Hypotonic

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5
Q

What is the chloride level of normal saline

A

154 mmol/L

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6
Q

What is the pH of normal saline (Acidotic, alkaline or neutral)?

A

Acidotic

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7
Q

Hartmann’s solution should be avoided in AKI with…?

A

Hyperkalaemia

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8
Q

What is the indication for using 1.26% sodium bicarbonate as a volume expander?

A

Metabolic acidosis

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9
Q

What should the use of starches be avoided with?

A

AKI

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10
Q

What are the systemic inflammatory diseases that can affect the kidneys?

A 
- Anti-neutrophil cytoplasmic antibodies (ANCA)  associated vasculitis:
> Microscopic polyangiitis
> Wegener's granulomatosis
> Churg-Strauss angiitis
- Anti-glomerular basement membrane (Anti-GBM) disease
> Systemic lupus erythematosus (SLE)
> Cryoglobulinaemia
> Henoch-Schonlein purpura (HSP)
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11
Q

What are the three broad groups of diseases that can cause rapidly progressing glomerulonephritis? (RPGN)?

A
  1. Renal related vasculitides
  2. Anti-GBM disease
  3. Immune complex glomerulonephritis
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12
Q

What are the characteristics of Wegner’s granulomatosis?

A

characteristically has ear, nose and throat (ENT), and/or respiratory involvement. Necrotising granuloma may cause sinusitis, nasal discharge, damage to the nasal septum, hearing loss and/or haemoptysis

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13
Q

What are the common causes of obstructions from within the lumen?

A

Urinary stones

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14
Q

What are the common causes of obstructions from within the wall?

A
  • Urothelial tumours

- Pelvi-ureteric junction obstruction (congenital abnormality)

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15
Q

What are the common causes of extrinsic compression?

A
  • Benign prostatic hypertrophy
  • Prostatic malignancy
  • Other pelvic or retroperitoneal malignancies
  • Retroperitoneal fibrosis
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16
Q

What are the key points you would want to cover in taking a history of a patient with AKI to try to avoid missing the diagnosis of urinary obstruction?

A 
- Lower urinary tract symptoms (LUTS):
> Hesitancy
> Poor stream
> Interrupted stream
> Dribbling
> Nocturia
- Urinary flow:
> Anuria
- Symptoms of urinary stones:
> Stone/gravel in urine
> Ureteric colic
> Renal colic
> Past history of unexplained loin/flank pain
- Symptoms suggesting urological problem:
> Visible haematuria
17
Q

What are the key points you would want to cover when examining a patient with AKI to try to avoid missing the diagnosis of urinary obstruction?

A
  • Inspect for scars of previous renal/urinary surgery
  • Palpate/percuss for bladder
  • Digital rectal examination (DRE)
18
Q

If it looks like the cause of AKI is obstruction, what test should be performed?

A

Ultrasound examination of the urinary tract

19
Q

If the most likely diagnosis was a renal inflammatory cause of AKI, what test should be performed?

A

Reagent strip urinanalysis

20
Q

If the diagnosis is urinary outflow obstruction, what is the most appropriate intervention?

A

Urethral catheter

21
Q

What are the 6 ECG changes that happen in hyperkalemia?

A
  1. Tented T waves
  2. Prolongation of PR interval
  3. Reduction in the amplitude of P waves/loss of P waves
  4. Widening of QRS complex
  5. Sinusoidal rhythm
  6. Ventricular fibrillation (VF)/ ventricular tachycardia (VT) or asystole
22
Q

What treatments rapidly lower serum potassium levels?

A

> Insulin- dextrose infusion
Nebulised salbutamol
IV sodium bicarbonate

23
Q

In patients with AKI, what treatments should be given to lower serum potassium levels?

A

> Calcium resonium

> Haemodialysis

24
Q

What are the key indications for dialysis in an AKI setting?

A
  • Hyperkalaemia causing significant ECG changes, refractory to medical management, not some arbitrary level of serum potassium
  • Failure of medical therapy to control pulmonary oedema
  • Uraemic complications such as pericarditis (which can transform into haemorrhagic pericarditis with subsequent haemodynamic compromise) or encephalopathy, not some arbitrary level of serum urea or creatinine
  • Acidosis causing circulatory compromise, not some arbitrary level of arterial blood pH
25
Q

What are the 2 life-threatening complications of AKI?

A
  • Hyperkalaemia

- Pulmonary oedema

26
Q

What conditions can arise as a consequence of a fluid challenge?

A
  • Acidosis
  • Fluid excess
  • Fluid overload
  • Gut oedema
  • Hyperchloraemia
  • Hyperchloraemic acidosis
  • Hyperkalaemia
  • Hyponatraemia
  • Intestinal oedema
  • Oedema
  • Pulmonary oedema
27
Q

What fluids can cause pulmonary oedema?

A
  • 0.9% sodium chloride
  • Hartmann’s solution
  • Other crystalloids
  • Colloids
  • Blood
28
Q

What fluids can cause hyponatraemia?

A
  • 5% dextrose

- Dextrose saline

29
Q

What fluids can cause Hyperkalaemia?

A
  • Blood (red blood cells release intracellular potassium)

- Hartmann’s solution

30
Q

What fluids can cause hyperchloraemic acidosis?

A

0.9% sodium chloride

31
Q

Describe the basal crackles in pulmonary oedema

A
  • Moderately numerous
  • Course or fine
  • Mide to late in inspiration
32
Q

Describe the basal crackles in COPD

A
  • Few
  • Coarse or fine
  • Early in inspiration
33
Q

Describe the basal crackles in Pulmonary fibrosis

A
  • Numerous
  • Fine
  • Late inspiration
34
Q

Describe the basal crackles in bilateral infection

A
  • Few
  • Coarse
  • Throughout
35
Q

Below what level of urine output would oliguria be diagnosed?

A

0.5 ml/kg/h

Renal (2 decks)

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