Acute Kidney Injury

Question 1

An AKI is defined as a rapid reduction in kidney function over what period of time?

Answer 1

Hours - days

Question 2

An AKI can be diagnosed if there is a rise in creatinine by more than what in a 48h period?

Answer 2

26micromol/litre

Question 3

An AKI can be diagnosed if the creatinine level rises by more than what times the baseline level?

Answer 3

1.5 x baseline

Question 4

A stage 1 AKI can be diagnosed if an individual’s urine output has been < 0.5ml/kg/hour for how long?

Answer 4

More than 6 consecutive hours

Question 5

What is the staging system used for AKIs?

Answer 5

KDIGO staging

Question 6

An increase in serum creatinine 1.5-1.9x baseline indicates which stage of AKI?

Answer 6

Stage 1

Question 7

A stage 2 AKI can be diagnosed if an individual’s urine output has been < 0.5ml/kg/hour for how long?

Answer 7

More than 12 consecutive hours

Question 8

What is the serum creatinine criteria for a stage 2 AKI?

Answer 8

Serum creatinine 2 - 2.9 x baseline

Question 9

A stage 3 AKI can be diagnosed if serum creatinine is more than 3 x baseline value, or if the serum creatinine is greater than what value?

Answer 9

354micromol/litre

Question 10

What is the urine output criteria for diagnosing a stage 3 AKI?

Answer 10

< 0.3ml/kg/hour for > 24 hours OR anuria for 12 hours

Question 11

What other factor would indicate a stage 3 AKI, irrespective of the serum creatinine or urine output?

Answer 11

The need for RRT

Question 12

What is the mechanism of a pre-renal AKI?

Answer 12

Renal hypoperfusion

Question 13

What are some examples of pre-renal causes of an AKI?

Answer 13

Hypovolaemia, hypotension, sepsis

Question 14

What is the mechanism of a post-renal AKI?

Answer 14

Urinary tract obstruction

Question 15

What are some examples of post-renal causes of an AKI?

Answer 15

Tumours, stones, prostatic enlargement

Question 16

Untreated pre-renal AKI can lead to what complication, causing a renal AKI?

Answer 16

Acute tubular necrosis

Question 17

What investigations should be performed to identify any life-threatening hyperkalaemia in individuals with an AKI?

Answer 17

U&E and ECG

Question 18

Which five bedside tests should be done in all individuals with an AKI?

Answer 18

Urinalysis, urine microscopy, bloods, ABG and ECG

Question 19

If signs of infection are present in an individual with an AKI, what additional blood test should be done?

Answer 19

Blood cultures

Question 20

If a systemic cause of AKI is suspected, what additional investigations should be performed?

Answer 20

Blood film and immunology tests

Question 21

What is the first line imaging test for an AKI if necessary?

Answer 21

Renal ultrasound

Question 22

What is the second line imaging test for an AKI if necessary?

Answer 22

CT-KUB

Question 23

If there is an AKI with complete anuria, the cause is most likely to be what?

Answer 23

Obstructive

Question 24

What is the first line management for a patient with an AKI and anuria?

Answer 24

Catheterisation

Question 25

What are the two urgent indications for a renal biopsy in individuals with an AKI?

Answer 25

Suspected rapidly progressive GN or positive immunology

Question 26

You should not perform a renal biopsy if what type of AKI is suspected?

Answer 26

Post-renal

Question 27

Which patients with an AKI should undergo a myeloma screen?

Answer 27

Those aged > 50 with hypercalcaemia and anaemia

Question 28

What does a myeloma screen involve?

Answer 28

Protein electrophoresis and urine testing for Bence-Jones proteins

Question 29

How should fluids be given in patients with an AKI?

Answer 29

250ml bolus' of crystalloid, reassessing fluid status after each one

Question 30

Senior help should be sought if a patient with an AKI has shown no improvement after receiving how much fluid?

Answer 30

1 litre

Question 31

Fluids containing what should be avoided in patients with an AKI?

Answer 31

Potassium

Question 32

Which drugs should always be withheld in patients with an AKI?

Answer 32

Gentamicin, ACE inhibitors/ARBs, NSAIDs

Question 33

When should metformin be withheld in patients with an AKI?

Answer 33

If creatinine is > 150micromol/l

Question 34

How should fluid status be monitored in patients with an AKI?

Answer 34

Fluid status should be assessed hourly, a fluid balance chart should be completed daily and daily weights should be taken

Question 35

How often should U&Es be tested in a patient with an AKI?

Answer 35

Daily

Question 36

How should AKIs be treated in order to be resolved?

Answer 36

Treat the underlying cause

Question 37

What happens to T waves and P waves in an ECG of someone with hyperkalaemia?

Answer 37

T waves are tall and tented, P waves are small or absent

Question 38

What happens to the PR interval in an ECG of someone with hyperkalaemia?

Answer 38

Increased

Question 39

What happens to the QRS complex in an ECG of someone with hyperkalaemia?

Answer 39

Broadened

Question 40

What is the immediate treatment to protect the myocardium in individuals with hyperkalaemia?

Answer 40

10mls 10% calcium gluconate IV over 2 minutes (repeat until ECG improves)

Question 41

What is the immediate treatment to move potassium back into cells in individuals with hyperkalaemia?

Answer 41

IV insulin (10 units Actrapid) and 50mls 50% dextrose over 30 minutes

Question 42

As well as insulin and dextrose, what other treatment can be used to shift potassium back into cells in individuals with hyperkalaemia?

Answer 42

Nebulised salbutamol

Question 43

What are the 4 major complications of an AKI, that are usually indications for the need for RRT?

Answer 43

Hyperkalaemia, pulmonary oedema, uraemia, acidaemia

Question 44

What drug is used to treat acute pulmonary oedema?

Answer 44

Furosemide

Question 45

What drug can be used to manage acidaemia?

Answer 45

Sodium bicarbonate

Question 46

Which type of renal replacement therapy is used in haemodynamically stable patients with an AKI?

Answer 46

Haemodialysis

Question 47

Which type of renal replacement therapy is used in haemodynamically unstable patients with an AKI?

Answer 47

Haemofiltration

Question 48

A potassium level of greater than what indicates the need for RRT in patients with an AKI?

Answer 48

7mmol/l

Question 49

A pH of less than what indicates the need for RRT in patients with an AKI?

Answer 49

7.2

Question 50

Overdoses with which drugs may require the need for RRT?

Answer 50

Barbiturates, lithium, alcohol (and ethylene glycol), salicylates and theophylline