Acute Kidney Injury (AKI) Flashcards
(37 cards)
What percentage of hospital inpatients get an AKI during their stay?
20%
More patients die in the short term (90 days) following an AKI than in the long term. TRUE/FALSE?
TRUE
How is AKI defined?
An abrupt (<48hrs) reduction in kidney function
How is AKI classified?
A1 = Increase of serum creatinine by 1.5-1.9x baseline A2 = Increase of serum Creatinine by 2.-2.9x baseline A3 = Increase of serum Creatinine by >3x baseline OR the need for RRT
What are the risk factors for the development of an AKI?
Older Age CKD Diabetes Cardiac Failure Liver Disease Perpiheral Vascular Disease Previous AKI
What is the main cause of pre-renal AKI?
Too little volume entering the glomerulus of the kidney
=> Hypotension
=> Hypovolaemia
=> Hypoperfusion of kidney
What can cause hypovolaemia and cause a pre-renal AKI?
Haemorrhage Volume depletion (e.g. Diarrhoea/Vomiting, burns)
What causes of hypotension can also cause an AKI?
Cardiogenic shock (e.g Heart Failure)
Distributive shock (e.g. sepsis, anaphylaxis)
What drugs are known to cause renal hypoperfusion?
- NSAIDs
- ACEi / ARBs
- Hepatorenal syndrome
What normally happens to conteract low renal perfusion?
Angiotensin 2 constricts efferent arteriole
=> maintains GFR
Why do ACEi cause a major fall in GFR when there is decreased renal perfusion?
They block angiotensin 2 from constricting the efferent arteriole
Untreated pre-renal AKI results in what?
Acute tubular necrosis
What are the most important causes of Acute tubular necrosis?
Sepsis
Severe dehydration
Rhabdomyolosis
Drug toxicity
What can we assess to see if a patient is dehydrated?
BP/ HR
Urine Output
JVP/Oedema/Pulmonary oedema (may indicate fluid overload)
Cap Refill
What fluid should be given for hypovolaemia in AKI?
Crystalloid (0.9% NaCl)
Do NOT use 5% dextrose (as it doesnt stay in the intravascular space and increase BP)
What bolus of fluids should be given at first?
250mls
If >1000mls IN and no improvement, seek help
What are the renal causes of AKI?
- Vascular
- Glomerulonephritis
- Interstitial Nephritis
- Tubular Injury
What can cause interstitial nephritis?
Drugs (NSAIDs, PPI, Penicillin)
Infection (TB)
Systemic (sarcoid)
What can cause tubular injury and eventually AKI?
- Ischaemia
- Drugs (gentamicin)
- Contrast
- Rhabdomyolysis
A mention of sore throat in a history would point towards which cause of renal disease?
Group A strep. infection
Rash and joint pains would point towards what cause of AKI?
Vasculitis
What cause of AKI may be indicated by haemoptysis?
ANCA associated vasculitis (due to lung involvement)
OR
Goodpasture’s Syndrome (anti-GBM)
If abnormal clotting was identified, what could be the cause of AKI?
Sepsis
If one kidney was visibly bigger than the other, what is thought to be the cause?
Renal vascular issue
e.g. artery stenosis
