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Flashcards in AKI Deck (56)
1

What is an abrupt (<48hrs) reduction in kidney function defined as?

an absolute increase in serum creatinine by >26.4µmol/l

OR increase in creatinine by >50%

OR a reduction in UO (urine output)

Can only be applied following adequate fluid resuscitation & exclusion of obstruction

2

Increase >26µmol/L or
Increase > 1.5-1.9 x reference Cr

< 0.5 mL/kg/hr for > 6 consecutive hrs

KDIGO stage 1

3

Increase > 2 to 2.9 x reference SCr

< 0.5mL/kg/hr for > 12 hrs

KDIGO stage 2

4

Increase > 3 x reference SCr or increase to > 354
µmol/L or need for RRT

24hrs or 12 hrs for anuria

KDIGO stage 3

5

Drugs which could cause renal hypoperfusion?

NSAIDs/COX-2
ACEi/ARBs
Hepatorenal syndrome

6

Normal urine output?

0.5ml/kg/hour

7

What is oliguria?

<0.5ml/kg/hour

8

Antiotensin II and arteriolar vasoconstriction and ACEi's

ACE inhibitors reduce Angiotensin II. Angiotension II mediates arteriolar vasoconstriction therefore increasing GFR. ACE I therefore can cause a fall in GFR by causing effferent arteriolar vasodilation.

9

Why can volume depletion/sepsis cause AKI?

Volume depletion/sepsis lead to decreased effective intravascular volume

This leads to increased ADH & aldosterone

Salt and water are retained

Then you get OLIGURIA

= AKI!

10

Untreated pre-renal AKI leads to what?

Acute tubular necrosis

11

What is the commonest form of AKI in hospital?

Acute tubular necrosis

12

Commonest causes of acute tubular necrosis?

Sepsis and severe dehydration
-other causes include rhabdomyolosis and drug toxicity

13

Treatment for pre-renal AKI?

-Access for hydration
-Fluid challenge for hypovolaemia

14

How would you assess for hydration?

Clinical observations (BP, HR, UO)
JVP, capillary refill time, oedema
Pulmonary oedema

15

What is the fluid challenge for hypovolaemia in AKI?

Crystalloid (0.9% NaCl) or Colloid (gelofusin)
DO NOT USE 5% DEXTROSE

Give a bolus of fluid and then reassess and repeat as necessary
If >1000mls IN and no improvement, seek help!!

16

Cast nephropathy is a typical renal complication found in patients with which condition?

Multiple myeloma

17

Diseases causing inflammation or damage to cells causing AKI?

RENAL AKI

18

Vascular causes of renal AKI?

Vasculitis
Renovascular disease

19

Glomerular causes of renal AKI?

Glomerulonephritis

20

Interstitial nephritis causes of renal AKI?

Drugs
Infection (TB)
Systemic (sarcoid)

21

Tubular injury as cause of renal AKI?

Ischaemia—prolonged renal hypoperfusion
Drugs (gentamicin)
Contrast
Rhabdomyolysis

22

Signs and symptoms of AKI?

Non specific symptoms

Anorexia, weight loss, fatigue, lethargy
Nausea & Vomiting
Itch
Fluid overload
Oedema, SOB

Signs
Fluid overload incl HTN, Oedema, Pul oedema, effusions (pleural & pulmonary)
Uraemia incl itch, pericarditis
Oliguria

23

Cardio complication of renal AKI?

Uraemic pericarditis

24

Renal causes of eosinophila?

Interstitial nephritis
Infection
Eosinophilic cystitis

25

HUS triad?

Anemia
Thrombocytopenia
Acute kidney injury

26

Haematoproteinuria suggests what?

Active glomerulonephritis

27

ANA

SLE

28

ANCA

Vasculitis

29

GBM

Goodpastures

30

BJP?

Bence jones protein
-Used to diagnose and monitor mutliple myeloma

31

Initial invesitgations for MM?

Protein electrophoresis and BJP (bence-jones protein)
-Everyone over 50 years

32

What might low platelets suggest?

HUS
TTP

33

What might abnormal clotting suggest?

DIC
Septic

34

What might anaemia suggest?

CKD
Myeloma

35

How would you diagnose a recent streptococal infection? e.g. if looking for cause of glomerulonephritis?

Culture (swab from throat or infected skin)
Serum antistrepsolysin-O titre

36

Culture (swab from throat or infected skin)
Serum antistrepsolysin-O titre

Used to diagnose streptococcal infection

37

Urgent indications for renal biopsy?

Suspected rapidly progressive GN

Positive Immunology & AKI

38

Semi-urgent indications for renal biopsy?

Unexplained AKI to gain a diagnosis

Rule out obstruction, Volume depletion & ATN

39

Life-threatening complications of AKI?

Hyperkalaemia
Fluid Overload (Pulmonary oedema)
Severe Acidosis (pH < 7.15)
Uraemic pericardial effusion
Severe Uraemia (Ur >40)

40

What is severe acidosis?

pH <7.15

41

What is severe uraemia?

Ur >40

42

What is thrombotic microangiopathy?

Thrombosis in capillaries and arterioles due to endothelial injury

43

What is post renal AKI?

Obstruction of urine flow leading to back pressure (hydronephrosis) and thus loss of concentrating ability

44

Normal ranges of potassium?

3.5-5

45

Hyperkalemia?

>5.5

46

Life threatening hyperkalemia?

>6.5

47

How could you assess hyperkalemia?

ECG
Muscle weakness

48

ECG changes associated with hyperkalemia?

Normal

Peaked T waves

Flattened P waves, prolonged PR interval, depressed ST segment, peaked T wave

Atrial standstill, prolonged QRS duration, further peaking T waves

Sine-wave pattern

49

Treatment for hyperkalemia?

Cardiac monitor & IV access

Protect myocardium!
(10mls 10% calcium gluconate)

Move K+ back into the cells
-insulin (actrapid 10 units) with 50mls 50% dextrose (30 minutes)
-Salbutamole nebs (90minutes)

Prevent absorption from GI tract
(calcium resonium--> but not in acute setting)

50

Urgent indications for HD?

Hyperkalemia (>7, >6.5 unresponsive to medical therapy)

Severe acidosis (pH 40, pericardial rub/effusion

51

Urgent indications for hemodialysis? HAFU

Hyperkalemia
Acidosis, severe
Fluid overload
Urea

52

Consequences of AKI?

Increased hospital stay
Higher costs
Increased mortality
Increased risk of future CKD

53

40 year old male presenting with general malaise & haemoptysis (Urea 28, Creatinine 600, elevated ant-GBM)

Goodpasture's syndrome

54

25 year old IVDA found collapsed at home

Rhabdomyolosis

55

82 year old man admitted with BP 70 30, T 39, pulse 140bpm, K+ 7.0, urea 48, Cr 789, CRP 250, CXR left basal consolidation

Acute tubular necrosis

56

72 year old man presenting with difficulty passing urine and reduced urine output

Obstructive uropathy