AKI Flashcards
(20 cards)
aki definition …
Abrupt disruption in the renal function over hours to days
usually reversible, but can be life threatening and cause electrolyte distrubances
2 ways to diagnose AKI
increase in serum creatinine
Decrease in urine output
What are the ways to measure the stage of the AKI (3 stages)
(can look up online or use Pnemonic RIFLE)
Other causes for increased/ decreased conc of urea apart from renal
Decrease - Low protein intake, liver failure, sodium Valproate treatment,
Increased - Cortico treatment, gastro bleeding
Other causes for increased/ decreased conc of creatinine apart from renal
Decrease - Low muscle mass
Increased
High muscle mass
red meat eating
Muscle damage
Reason for pre renal AKI and common causes
Falling blood flow, reduces GFR. Changes in circulation, not longer perfusing kidney. mAYBE DUE TO -
Hypovolaemia of any cause (bleeding/ dehydration)
Hyportension without hypovoloaemia (cirrhosis/ septic shock)
Low cardiac output (heart failure/ cariogenic shock)
NSAIDS (reduce prostaglandins), ACEi etc
Causes of hypovolaemia
Search up
There are some urine specific osmolality figures which can show if it is pre renal AKI
urine specific gravity
Urine osmolality
Urine sodium
Management of pre renal AKI - need to go over somewhere else
Post renal AKI, how does it occur plus examples
Basically due to any obstruction from calyces to the external urethra e.g. Prostatic issues/ calculi
Give some causes of parenchymal AKI
Acute tubular necrosis (ischaemic or due to toxins)
Disease affecting the infrarenal arterys and capillaries (vasculitis/ embolism etc)
ATN (acute tubulonecrosis nephritis)
Pyelonephritis (acute)
Acute tubular necrosis occurs due to …
sustained undwrperfusion of the renal tubules
Nephrotoxins causing direct injury and cell death
Think of some factors which may cause development of ATN (examples)
Look in the K&C textbook, pg 771, for all 5 examples, in detail)
What are all of the symptoms of AKI
Symptoms of uraemia - anorexia, nausea, vomiting, pruritus
Cloudy head, drowsiness, fits, coma and haemorrhage episodes.
What are some signs of AKI
Signs from the underlying cause - - -
e.g. infection etc
What 3 metabolic and 1 physiological abnormalities may be present in AKI
Metabolic -
Hyperkalaemia (esp with sepsis and trauma)
Metabolic acidosis (usually, unless loss of H via vomit etc)
Hyponatraemia (water overload
Pulmonary oedema
What investigations may be done in order to distinguish pre/ post/ intra renal
Feel bladder (outflow obstruction)/ ultrasound of kidney and bladder for post renal
Urinanalysis - for haemo and myoglobin, as well as for urine protein: creatinine ration (if parenchymal disease is possible)
Urinary and plasma biomarkers (not creatinine necessarily because this takes long time to rise in blood - may be damage by then)
Bloods - serum urea/ electrolytes/ creatinine/ phosphate/ albumin/
How to tell if acute of chronic uraemia?
AKI vs CKD
Depends on symptoms and duration …
Ultrasound - if kidneys small/ scarred, suggests long process of damage.
Please look at K&C book for full management of AKI 773. Here list what we will need to manage
General
Hyperkalaemia
Pulmonary Oedema
Sepsis
Use of drugs
Fluid and electrolyte balance
Nutrition
RRT - harm-dialysis/ filtration
Recovery phase management
Again, read in book other cause of AKI, but list them here (7)
Rhabdomyolysis
Acute cortical necrosis
Contrast nephropathy
Acute phosphate nephrothapy
Tumour lysis syndrome
Hepatorenal syndrome.
