Acute kidney injury Flashcards

Question

Mx of metabolic acidosis

Answer 1

if pH \<7.2 50-100mL of 8,4% bicarbonate via central line over 15-30mins will generate CO2 so need adequate ventilation to stop resp acidosis making it worse sodium bicarb can alsoe ppte a fluid overload in a vulnerable patient

Answer 2

ox - consider CPAP IV GTN 2-10mg/h IV furosemide - 250mg over 1hr followed by infusion 5-10mg/h IV diamorphine - single doe of 2.5mg - relieves anxiety and breathlessness

Answer 3

IV fluids if volume depleted - 500ml colloid or 0.9% saline over 30mins - assess response (ie UO or CVP) - continue until CVP 5-10cm inotropes if hypotension persists in spite of CVP \>10cm treatment of infection - dose in view of the renal impairment stop the nephrotoxic drugs (eg ACEi and NSAIDS) and non-essential drugs idenyify intrinic renal disease and treat relieve the obstruction eg urinary catheter, nephrostomies

Answer 4

persistant hyperkalaemia \>7mmol/L fluid overload - refractory pulmonary oedema pericarditis acidosis - arterial pH \<7.1, bicarb \<12 symptomatic uraemia (tremor, cognitive impairment, coma, fits, urea typically \>45mmol/L) - encephalopathy or pericarditis

Answer 5

continuous arteriovenous or venous-venous filtration of plasma water across the membrane induced by the hydrostatic pressure gradient and convective transport of solutes in the same direction as water substitution fluid is needed to prevent excessive fluid removal

Answer 6

intermittent haemodialysis (using central venous catheters or arteriovenous fistulae) or peritoneal dialysis (using a double cuff straight Tenckhoff catheter) solutes passively diffuse down their concentration gradient (urea, creatinine, and K more from blood to dialysate; ca and bicarb move from dialysate to blood venesect 250-500ml if delay for dialysis

Answer 7

depends on availability, expertise, haemodynamic stability, vascular access and whether primary need is for fluid and/or solute removal haemofiltration is preferred if hypotensive or haemodynamically unstable - because rate of fluid and solute removal is slow

Answer 8

isotonic saline to maintain diuresis of 200-300ml/h careful monitor for fluid overload if diuresis is established - switch to alkaine soln (bicarb) increasing urine pH to \>6.5 may reduce release of free iron from myoglobin and intratubular pigment deposition and cast formation if desired diuresis is not established with adequate volume replacement alone - loop diuretics or mannitol

Answer 9

thalidomide and dexamethasone to reduce light chain production isotonic fluids (aim UO \>=3L/day) careful monitoring for fluid overload

Answer 10

allopurinol loop diuretic and fluids - wash out obstructing uric acid crystals haemodilaysis of diuresis cannot be induced

Answer 11

effects of muscle mass and dilution but no biomarker has superseded it

Answer 12

is there a life threatening complication: * NEWS * pul oedema * hyperkalameia examine - HR, BP, JVP, cap refill, palpate for bladder treat hypovolaemia monitor: * fluid balance - catheter * K * obs * lactate if signs of sepsis * daily creatinine until it falls Ix support * treat sepsis * stop nephrotoxic med - NSAIDs, ACEi, ARB, aminoglycosides * stop drugs that increase complications - diuretic (esp K sparing), metformin, antiHTN * check all doses appropriate * gastroprotection and nutritional support * avoid radiological contrast

Answer 13

correct volume depletion and/or increase renal perfusion via circ/cardiac support treat sepsis

Answer 14

refer for likely biospy and specialst treatment of intrinsic renal disease

Answer 15

catheter nephrostomy urological intervention

Answer 16

risks of dialysis catheter insertion and maintenance procedurla hypotension bleeding due to the requirement for anticoag alterned nutrition and drug clearance

Answer 17

* decreased blood supply to kidneys * = failure of renal vascular autoregulation to maintain renal perfusion * = reduced GFR * = activation of RAAS * = increased aldosterone release * = increased absorption of Na and water * = increased urine osmolarity * = secretion ADH * = increased resporption of water and urea * creatinine still secreted in the proximal tubule so the blood BUN:creatinine ratio increases

Answer 18

damage to vascular or tubular component of nephron = necrosis or apoptosis of tubular cells = decreased resorption capacity of electrolytes (Na, water, and/or urea) = increased Na and water in urine = decreased urine osmolarity

Answer 19

bilateral urinary outflow obstruction = increased retrograde hydrostatic pressure in renal tubules = decreased GFR and compression of the renal vasculature = acidosis, fluid overload, increased BUN, Na, K normal GFR can be maintained as long as one kidnye functions normally

Answer 20

1. **initiating event** = sx of **underlying illness,** hours/days 2. **oliguric/anuric** = **reduced UO, increased urea and creatinine retention -** complications: pul oedema, high K, met acidosis, uraemia, lethargy, asterixis 3. **polyuric/diuretic phase** = glomerular function returns to normal - **polyuria**, **tubular resorption still disturbed** - complications: loss of electrolytes and water - dehydration, low K, and Na 4. recovery phase = **normal**

Answer 21

caused by ischemia or nephrotoxic substances * eg hypotn, thromboembolism, thrombotic microangiography, cholesterol embolism * contrast, aminoglycosides, cisplatin, myoglobinuria due to rhabdomyolysis, haemoglobinuria associated with haemolysis, acute uric acid nephropathy necrotic prox tubular cells fall into the tubular lumen - debris obstructs tubules - decreased GFR - pre-renal AKI

Answer 22

deterioration of kidney function in patients with advanced liver disease cirrhosis/portal HTN = increase in splanchnic vasodilators eg nitric oxide = low arterial blood flow = activation of RAAS = renal vasoconstriction = low GFR features of advanced liver disease, oliguria -\> anuria with progressive kidney failure, hypotension with a wide pulse pressure

Acute kidney injury Flashcards

(46 cards)