Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Nephrology > AKI > Flashcards

AKI Flashcards

(65 cards)

Start Studying
1
Q

Define AKI criteria

A

Rise in serum creatinine of 26 micro mol/L or greater within 48 hours

50% of greater rise in serum creatinine within past 7 days

Fall in urine output to <0.5 ml/kg/hour for more than 6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Is creatinine or eGFR better for measuring AKI and why

A

Creatinine since it exclusively excreted by the kidneys
eGFR better for CKD
Urea also measured for AKI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk factors of AKI

A

Over 65y
History of AKI / CKD with GFR <60
Urinary obstruction symptoms
Heart failure
Liver disease
Diabetes
HTN
Neurological/cognitive impairment e.g. Stroke
Sepsis
Exposure to nephrotoxins / iodinated contrast agents
Perioperative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

AKI signs and symptoms presentation

A

Reduced urine output - oligouria
Change in urine (frothy - proteinuria, dark, haematuria)
Possible dysuria
Signs of underlying cause - sepsis (pyrexia), rash from vasculitis
Signs of raised urea - Confusion/drowsiness, n+v, pruritis, fatigue
Fluid overload / Hypovolaemia signs - oedema and hypertension

Signs
- rapid rise in serum creatinine and urea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name nephrotoxins

A

NSAIDs / COX2is
ACEi / ARB
Thiazide/loop diuretics
Potassium sparing diuretics
Metformin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Trimethoprim association with AKI

A

Trimethoprim is an antibiotic used for UTI
Interferes with creatinine secretion from tubules into urine - high creatinine may not be from AKI!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you know raised creatinine is from AKI and not from CKD

A

If creatinine raise over a day or week is consistent with CKD instead of acute raise, it’s CKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pregnancy association with AKI

A

Creatinine may be raised post pregnancy and doesn’t mean AKI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 3 different volume statuses

A

Dehydration/ hypovolaemia
Uraemia
Hypervolaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Components that can be checked in fluid balance assessment

A

Blood pressure
Urine output
Oedema - sacrum/peripheral
JVP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 3 categories of AKI

A

Pre renal
Intra renal (intrinsic)
Post renal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Mechanism of pre renal AKI

A

Decreased renal perfusion

  • shock (hypovolaemic, cardiac, distributive)
  • decreased circulating volume e.g. dehydration
  • decreased cardiac output e.g. cardiac failure
  • liver failure / cirrhosis
  • systemic vasodilation e.g. sepsis, hypotension
  • arteriolar changes in the glomeruli e.g. from ACEi, ARBs or NSAID use
  • renovascular disease (renal artery stenosis) - more likely for CKD though
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of Hypovolaemia

A

Haemorrhage
Diuresis
GI loss (vomitting, diarrhoea)
Skin - sweating/burns
Reduced water intake / electrolyte intake
Medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

AKI characterisation

A

Increased creatinine and urea with oligouria (abnormally reduced urine output)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Renal artery stenosis presentation and clinical signs

A

Accelerated and difficult to control HTN
AKI post ACEi/ARB initiation
Progressive CKD
EPISODES OF FLASH PULMONARY OEDEMA

  • bruit on abdominal examination
  • narrowing on renal artery MRI with angiography
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Diagnostic investigation for Renal artery stenosis

A

Renal arteriography
- can do CT or MRI though

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Indications for acute dialysis

A

AEIOU
A - acidosis (pH under 7.2)
E - electrolyte imbalance (resistant hyperkalaemia)
I - intoxication (drug overdose, poisoning)
O - oedema
U - uraemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is Intra renal AKI

A

AKI caused by intrinsic renal pathology (damage or dysfunction to glomerulus, bowman’s capsule, and or tubules)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is rhabdomyolysis

A

Skeletal muscle injury causing rapid breakdown and necrosis of skeletal muscle releases metabolic products e.g. myoglobin and potassium directly into blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Causes of rhabdomyolysis

A

Trauma - elderly fall leading to prolonged immobilisation (anaerobic conditions for muscles leading to breakdown), crush injuries, burns, seizures, compartment syndrome

Ischaemia related to- embolism, surgery

Toxin induced - medications (statins, vibrates, neuroleptics), recreational drugs (ecstasy)

Strenuous / extreme physical activity e.g. intense spin class

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What type of kidney issue can rhabdomyolysis lead to and why

A

Intra renal Acute kidney injury - metabolic products from skeletal muscle breakdown (myoglobin and potassium) damage glomeruli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Rhabdomyolysis symptoms

A

Muscle pain and swelling
Red / brown urinary - TEA OR COLA COLOURED - due to myoglobinuria
AKI occurs 10-12 hours after initial injury or pain onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Rhabdomyolysis clinical signs and investigations

A

SERUM CREATININE FIVE FOLD RAISE FROM UPPER LIMIT - due to muscle breakdown
Raised lactate dehydrogenase
Hyperkalaemia, hyperphosphataemia, hyperuraemia, hypercalcaemia

Positive urine dipstick for blood due to myoglobinuria with no red blood cells on microscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Rhabdomyolysis treatment and management

A

Supportive management with IV fluid to excrete myoglobin and monitor electrolytes

treat hyperkalaemia - if not managed may need emergency dialysis (due to risk of acute renal failure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What type of condition is nephritic and nephrotic syndromes?
Intra renal AKI
26
List nephritic syndrome conditions
IgA nephropathy - Berger’s disease - type of glomerulonephritis Post infectious glomerulonephritis Vasculitis Lupus nephritis Infective endocarditis driven immune complex mediated
27
Typical presentation of nephritic syndrome
Sudden onset - pt acutely unwell Some oedema RAISED BP some proteinuria and hypoalbuminaemia HAEMATURIA - cola coloured Oligouria May or may not hypercholesterolemia
28
Typical presentation of nephrotic syndrome
Gradual onset - pt more acutely well OEDEMA PROTEINURIA HYPOALBUMINAEMIA may or may not have haematuria HYPERCHOLESTEROLEMIA
29
What are the differences in nephritic and nephrotic syndrome presentations !!!
Nephritic - sudden onset so pt acutely unwell, RAISED BP, not much oedema, only some proteinuria and hypoalbuminaemia, lots of haematuria, may not have hypercholesterolemia Nephrotic - gradual onset so pt acutely well, lots of OEDEMA, NORMAL blood pressure, lots of PROTEINURIA and hypoalbuminaemia, HYPERCHOLESTEROLEMIA
30
Nephritic syndrome mechanism
Endothelial wall of Glomerular capillary wall damage from immune complex formation - sediments seen on microscopy IMMUNE SYSTEM MEDIATED
31
Investigations for nephritic syndrome
Urine dip for leukocytes (due to immune relation) proteins and blood Urine protein creatininratio (PCR) Acute renal screen
32
Management of nephritic syndrome
Urgent renal referral BP control - may have diuresis Treatment for underlying infection after confirming on microscopy / renal biopsy
33
What is IgA nepropathy and its mechanism
Most common type of glomerulonephritis (nephritic syndrome - Intra renal AKI) - glomerular deposits of immunoglobulin A lodges in glomerulus, IgA activates complement pathway and cytokines release - this all leads to glomerular injury
34
IgA nephropathy presentation
Recurrent / episodic haematuria Teen - thirties Common after URTI, resp or gastrointestinal infection Hypertension Mild proteinuria
35
IgA nephropathy investigations
Urinalysis - blood and protein Microscopy - dysmorphic red blood cells showing glomerular damage Urgent referral to renal Gold standard - renal biopsy Serum IgA raised in 50% of pts
36
IgA nephropathy management
Supportive management - salt restriction, hypertension management, proteinuria management (ACEi and ARB)
37
What is post infectious glomerulonephritis
Nephritic syndrome - Intra renal AKI Immune complex mediated glomerulonephritis
38
Presentation of post infectious glomerulonephritis
Children Sudden onset of haematuria 1-3 weeks after group A streptococci infection (URTI, throat or skin infection, infective endocarditis) Oedema 1-3 weeks after infection Hypertension
39
Post infectious glomerulonephritis investigations
Urinalysis - for blood, maybe protein Microscopy - dysmorphic red blood cells (sign of glomerular / renal bleeding) FBC - resided WBC due to infection Urea and electrolytes- sign of AKI Gold standard - renal biopsy - humps
40
What is vasculitis
Auto immune condition - nephritic syndrome - inflammation of small blood vessels and immune cell infiltration causing vessel wall damage e.g. haemorrhage / aneurysm or vessel occlusion
41
Vasculitis presentation
65-74 Systemic symptoms - weight loss, fevers, malaise, polyathralgia (pain in several joints) Depending on which blood vessels affected - in lungs (haemoptysis, pulmonary haemorrhages), ENT (epistaxis, sinusitis), eyes (conjunctivitis, episcelritis), cardiac (myocarditis) RENAL (HAEMATOPROTEINURIA, HYPERTENSION, PROGRESSIVE AKI) ANCA associated
42
Vasculitis management
Urgent same day referral for biopsy Immunosuppression depending on severity and frailty
43
Triad for diagnosing nephrotic syndrome
Fluid overload Low albumin Heavy proteinuria
44
What is nephrotic syndrome
Glomerular protein leakage - increased permeability to serum proteins in glomerulus due to damaged basement membrane
45
Presentation of nephrotic syndrome (symptoms and clinical signs)
Frothy urine - proteinuria Oedema Signs Hypoalbuminaemia HYPERLIPIDAEMIA (hypercholesterolemia) Lipiduria Pro-thrombotic tendency - venous thrombosis - blood clots
46
Causes of nephrotic syndrome
Lupus Amyloid Minimal change disease Membranous nephropathy
47
Investigation and management of nephrotic syndrome
Ix Urine dipstick - protein Urinalysis- albumin creative ratio raised Renal biopsy , acute renal screen to find cause Tx High dose corticosteroids Reduce proteinuria - ACEi and ARBs - proteinuria is risk factor for progression to CKD Depends on cause and symptoms - immunosuppression for lupus, BP management, diuresis for fluid overload/oedema prophylaxis for VTE
48
Multiple myeloma investigations
Bone profile - calcium levels FBC - anaemia and low platelets CT skeleton Serum protein electrophoresis Serum free light chains
49
Multiple myeloma treatment
IV hydration and correcti9n of hypercalcaemia Haematology referral Bone marrow biopsy Chemotherapy + dexamethasone
50
What is multiple myeloma and how does it cause kidney damage
Bone marrow cancer Hypercalcaemia and light chain deposition in glomerulus causes renal damage - Intra renal AKI
51
Lupus nephritis presentation + clinical signs
More often in women Afro-Caribbean and Asian predisposed Young adulthood Weight loss, fever, rash, Alopecia, pericarditis, headache, seizure, stroke, thrombocytopenia, athralgia, arthritis Clinical signs - proteinuria (due to autoimmune complex formation and deposition) Low grade haematuria Low albumin and raised PCR Raised ESR!!! Positive ANA
52
What is obstructive uropathy
Type of post renal AKI Obstruction increases Intra tract pressure as urine builds up causing hydronephrosis
53
What is hydronephrosis
Swelling and inflammation of obstructed kidney
54
When does obstructive uropathy lead to renal failure
Only present of single functioning kidney or is obstruction is bilateral (obstruction may be in bladder and below)
55
What are the 3 classifications of obstructive uropathy
Level of obstruction (upper is ureter and above so more likely unilateral , lower is bladder and below so more likely bilateral) Complete or partial obstruction (urine output varies in partial but complete causes ANURIA) Intrinsic or extrinsic (intrinsic cause within tract like stones, extrinsic cause outside of tract like BPH or ovarian mass)
56
Symptoms and clinical signs of obstructive uropathy
Pain (flank pain) Haematuria Changes to urine volume ANURIA!!! Dysuria Clinical findings Palpable bladder (full or urine) - dull on percussion Loin tenderness Flank mass - rare
57
Obstructive uropathy investigations
Urine MCS and urine dipstick Creatinine (may be normal if one kidney normal and compensating during unilateral obstruction) CRP, WBC and blood cultures PSA for men with lower urinary tract symptoms Ultrasound- - appearance may be delayed
58
Obstructive uropathy treatment - done by urology / renal team
Relieve obstruction - catheter - nephrostomy (if site of obstruction is further up then stent and block) Manage underlying cause Antibiotics due to stasis of urine
59
What is reflux nephropathy
Reflux of urine up ureters as bladder contracts during micturition
60
Complicati9ns of reflux nephropathy
UTIs Tubules scarring / atrophy If not resolved into adulthood will present as CKD / proteinuria
61
Reflux nephropathy presentation
Childhood most commonly due to abnormally developed urinary tract - becomes better when developed Prolonged bed wetting Frequent UTIs!!! - leukocytes and nitrates may be present on investigations Resolves in adulthood after urinary tract development or if not may present as CKD or unexplained proteinuria
62
What is pyelonephritis
Acute infection of ascending urinary tract and kidney
63
Diagnosis of pyelonephritis
Clinical diagnosis Only US if other symptoms e.g. incomplete bladder emptying, obstruction, stones , abscess
64
Pyelonephritis treatment
Urine MCS and Blood cultures then start antibiotics Manage AKI
65
Indications for emergency dialysis
Acidosis despite management Electrolytes - hyperkalaemia despite management Intoxication - drugs Overload - pulmonary oedema - remove extra fluid Uraemia - pt may be confused / drowsy

Nephrology (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions