AKI

Question 1

aki definition …

Answer 1

Abrupt disruption in the renal function over hours to days

usually reversible, but can be life threatening and cause electrolyte distrubances

Question 2

2 ways to diagnose AKI

Answer 2

increase in serum creatinine

Decrease in urine output

Question 3

What are the ways to measure the stage of the AKI (3 stages)

Answer 3

(can look up online or use Pnemonic RIFLE)

Question 4

Other causes for increased/ decreased conc of urea apart from renal

Answer 4

Decrease - Low protein intake, liver failure, sodium Valproate treatment,

Increased - Cortico treatment, gastro bleeding

Question 5

Other causes for increased/ decreased conc of creatinine apart from renal

Answer 5

Decrease - Low muscle mass

Increased
High muscle mass
red meat eating
Muscle damage

Question 6

Reason for pre renal AKI and common causes

Answer 6

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

Question 7

Causes of hypovolaemia

Answer 7

Search up

Question 8

There are some urine specific osmolality figures which can show if it is pre renal AKI

Answer 8

urine specific gravity
Urine osmolality
Urine sodium

Question 9

Management of pre renal AKI - need to go over somewhere else

Question 10

Post renal AKI, how does it occur plus examples

Answer 10

Basically due to any obstruction from calyces to the external urethra e.g. Prostatic issues/ calculi

Question 11

Give some causes of parenchymal AKI

Answer 11

Acute tubular necrosis (ischaemic or due to toxins)

Disease affecting the infrarenal arterys and capillaries (vasculitis/ embolism etc)

ATN (acute tubulonecrosis nephritis)

Pyelonephritis (acute)

Question 12

Acute tubular necrosis occurs due to …

Answer 12

sustained undwrperfusion of the renal tubules

Nephrotoxins causing direct injury and cell death

Question 13

Think of some factors which may cause development of ATN (examples)

Answer 13

Look in the K&C textbook, pg 771, for all 5 examples, in detail)

Question 14

What are all of the symptoms of AKI

Answer 14

Symptoms of uraemia - anorexia, nausea, vomiting, pruritus

Cloudy head, drowsiness, fits, coma and haemorrhage episodes.

Question 15

What are some signs of AKI

Answer 15

Signs from the underlying cause - - -

e.g. infection etc

Question 16

What 3 metabolic and 1 physiological abnormalities may be present in AKI

Answer 16

Metabolic -
Hyperkalaemia (esp with sepsis and trauma)

Metabolic acidosis (usually, unless loss of H via vomit etc)

Hyponatraemia (water overload

Pulmonary oedema

Question 17

What investigations may be done in order to distinguish pre/ post/ intra renal

Answer 17

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/

Question 18

How to tell if acute of chronic uraemia?

Answer 18

AKI vs CKD

Depends on symptoms and duration …

Ultrasound - if kidneys small/ scarred, suggests long process of damage.

Question 19

Please look at K&C book for full management of AKI 773. Here list what we will need to manage

Answer 19

General
Hyperkalaemia
Pulmonary Oedema
Sepsis
Use of drugs
Fluid and electrolyte balance
Nutrition
RRT - harm-dialysis/ filtration
Recovery phase management

Question 20

Again, read in book other cause of AKI, but list them here (7)

Answer 20

Rhabdomyolysis
Acute cortical necrosis
Contrast nephropathy
Acute phosphate nephrothapy
Tumour lysis syndrome
Hepatorenal syndrome.