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2 Renal > Acute Kidney Injury (AKI) > Flashcards

Acute Kidney Injury (AKI) Flashcards

(51 cards)

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1
Q

define AKI

A

an abrupt reduction in kidney function defined by:
inc in creatinine by >50%
reduction in urine output
THAT WONT RESPOND TO RESUS

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2
Q

what would be defined as an “abrupt” reduction in kidney function?

A

<48hrs

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3
Q

risk factors for AKI?

A 
old age
CKD
diabetes
HF
liver disease
PVD
previous AKI
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4
Q

what acute vascular problems can cause AKI?

A

hypotension

hypovolaemia

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5
Q

pre-renal causes are also know as…

A

functional causes

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6
Q

renal causes are also known as…

A

structural causes

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7
Q

post renal causes are also known as…

A

obstructive causes

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8
Q

what is affected first in AKI:
urine output
creatinine levels

A

UO

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9
Q

pre-renal causes of AKI?

A

hypovolaemia (eg dehydration)
hypotension
renal hypoperfusion

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10
Q

what drugs can cause renal hypoperfusion?

A

NSAIDs
COX-2 inhibitors
ACEi

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11
Q

what must be communicated to a renal patient when they’re started on an ACEi?

A

sick day rules - if they take their medication while ill theyre at risk of AKI

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12
Q

untreated pre-renal AKI leads to….

A

acute tubular necrosis

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13
Q

what forms of shock can cause AKI?

A

cardiogenic
septic
anaphylactic

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14
Q

define oliguria?

A

<0.5mls/kg/hr

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15
Q

how does angiotensin 2 increase GFR?

A

mediates arteriolar vasoconstriction

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16
Q

how does ACEi decrease GFR?

A

cause efferent arteriolar vasodilation

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17
Q

commonest form of AKI in hospital?

A

acute tubular necrosis

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18
Q

causes of acute tubular necrosis?

A

sepsis
severe dehydration
rabdomyolysis
drugs

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19
Q

Tx of pre-renal AKI?

A

assess for hydration eg oedema/JVP/cap refill

if deplete give 0.9% NaCl 1l

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20
Q

main drug causes of interstitial nephritis

A
  1. antibiotics

2. PPIs

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21
Q

non-drug causes of interstitial nephritis?

Study These Flashcards
A

TB

sarcoidosis

22
Q

patients who are itchy are more likely to have __ renal failure

23
Q

gentamicin is toxic to what part of the kidney?

24
Q

symptoms of AKI?

Study These Flashcards
A

general symptoms eg nausea
itch
fluid overload eg oedema, sob

25
signs of AKI?
oliguria fluid overload uraemia eg itch, pericarditis
26
if blood and protein are in the urine the AKI is more likely to be of a ___ cause
renal/structural
27
Hx of sore throat in a patient with AKI?
could have a strep GN leading to AKI
28
what results on blood tests could indicate renal causes of AKI?
eosinophilia | CK
29
Ix for AKI?
``` U+Es, FBC coagulation screen urinalysis USS immunology for ANA/ANCA protein electrophoresis and BJP ```
30
what are the different components of U+Es?
Na, K, Ur, Cr
31
anaemic patient with a vague history indicates chronic or acute disease?
chronic
32
small kidneys indicate...
chronic disease
33
measurement for goodpastures?
GBM
34
investigations for myeloma?
protein electrophoresis | BJP
35
when would you do a renal biopsy urgently?
rapidly progressive GN | positive immunology + have AKI
36
Ct guided biopsy is the gold standard for renal biopsy?
F, USS guided biopsy is
37
if the patient has been fluid rescitated and still doesnt have a good BP what should you do?
give inotropes and vasopressors
38
when should a patient with AKI go onto dialysis?
if patient remains anuric and uraemic after treatment
39
what is fluid overload?
pulmonary oedema with oliguria
40
when should diuretics absolutely not been given in a patient with oedema symptoms?
if they are not peeing
41
what level is classed as severe uraemia?
urea >40
42
what is the cause of AKI in post renal AKI?
obstruction | get obstruction of urine flow leading to back pressure -> hydronephrosis -> loss of concentrating ability
43
causes of post renal AKI?
stones cancers strictures extrinsic pressure
44
Tx of post renal AKI?
catheter | nephrostomy
45
normal K level?
3.5-5
46
patient with muscles feeling like jelly 2 days after dialysis?
hyperkalaemia
47
Ix for hyperkalaemia
muscle tests | ECG
48
why do we give calcium gluconate in hyperkalaemia?
stabilises myocardium and normalises ECG
49
what does insulin do in hyperkalaemia?
moves K+ back into the cells
50
Tx of hyperkalaemia
1. calcium gluconate 2. insulin dextrose 3. sodium bicarbonate
51
indications for dialysis in an AKI patient?
``` not responding to drugs in: hyperkalaemia severe acidosis (<7.15) fluid overload urea >40 with pericardial rub ```

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