AKI

Question 1

What is the definition of AKI?

Answer 1

Increase in Serum Creatinine
by ≥ 26.5 μmol/l (0.3 mg/dl ) within 48 hours; or
to ≥ 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or
Urine volume <0.5 ml/kg/h for 6 hours

Question 2

Describe AKI stage I?

Answer 2

1.5-1.9 x creatinine baseline
or >26.5 umol/l increase
Or <0.5ml/kg/h urine output for 6-12 hours

Question 3

Describe AKI stage 2 ?

Answer 3

2.0-2.9 x baseline creatinine

or <0.5ml.. urine output for >12 hours

Question 4

Describe AKI stage 3

Answer 4

3.0x baseline creatinine
Or increase to >354 umol 
Or initiation of RRT 
Or <0.3 ml.. urine for >24 hours 
Or anuria for >12 hours

Question 5

What are the immediate dangerous causes of AKI?

Answer 5

Acidosis
Electrolyte imbalance
Intoxication
Overload

Question 6

What are the 3 categories of causes of AKI?

Answer 6

Pre renal
Renal
Post Renal

Question 7

What is the commonest cause of pre-renal AKI?

Answer 7

Reduction in effective circulation volume

Question 8

What are some potential causes of pre-renal AKI?

Answer 8

Reduce effective circulation volume
- Volume depletion (haemmorhage / dehydration)
- Hypotension / shock (sepsis is major contributor)
- Congestive cardiac failure / Liver failure
Arterial occlusion
Vasomotor
- NSAIDs/ACE inhibitors

Question 9

What are some renal causes of AKI?

Answer 9

Acute tubular necrosis 
Toxin related 
Acute interstitial nephritis
Acute glomerulonephritis 
Myeloma 
Intra renal vascular obstruction

Question 10

What are some post renal causes of AKI?

Answer 10

Obstruction

Question 11

What can cause intraluminal obstruction

Answer 11

Calculus

clot

Question 12

What can cause intramural obstruction?

Answer 12

Malignancy
Ureteric stricture
Radiation fibrosis
Prostate disease

Question 13

What can cause extra mural disease?

Answer 13

Retroperitoneal fibrosis

Malignancy

Question 14

What is radiocontrast nephropathy?

Answer 14

AKI following administration of iodinated contrast agent

Question 15

What is the prognosis for radiocontrast nephropathy?

Answer 15

Usually transient renal dysfunction Resolving after 72hrs

May lead to permanent loss of function

Question 16

What are the risk factors for radiocontrast nephropathy?

Answer 16

DM 
Renovascular disease
Impaired renal function 
Paraprotein 
High volume of radiocontrast

Question 17

What direct history questions are relevant for AKI?

Answer 17

FH
Drug exposure
PMH

Question 18

What examinations/signs are relevant for AKI?

Answer 18

Flid status
Vital signs (BP, pulse)
Systemic illness

Question 19

What investigations should be done for AKI?

Answer 19

Urine dipstick 
Bloods 
FBC 
Blood gas
USS

Question 20

Which blood tests should be requested for AKI?

Answer 20

U&E
Bicarbonate
Clotting 
FBC 
ANCA
IG immunoglobulins 
C3 complement

Question 21

Which urine tests should be carried out?

Answer 21

Blood

Protein

Question 22

What histological investigations should be carried out for AKI?

Answer 22

Renal biopsy

Question 23

What are risk events for AKI?

Answer 23

Sepsis
Toxins 
Hypotension 
Hypovolaemia 
Major surgery

Question 24

What things can cause hypovolaemia?

Answer 24

Haemorrhage
Vomiting
Diarrhoea

Question 25

What are risk factors for AKI?

Answer 25

``` >75 Previous AKI HF Liver disease Chronic kidney disease Vascular disease ```

Question 26

Which toxins can cause AKI?

Answer 26

X-ray contrast NSAID's Gentamicin

Question 27

Which antibiotic is contraindicated in renal problems?

Answer 27

Gentamicin

Question 28

Which measures can be taken to supportively manage fluid balance in AKI?

Answer 28

``` Volume resuscitation if vol depleted Fluid restriction if vol. overload Optimise BP Give fluid/vasopressers Stop ACE inhibitors ```

Question 29

What is the management for toxin related AKI?

Answer 29

Stop nephrotoxic drug Do not give IV radiocontrast unless needed Use antidote if available

Question 30

What step should be taken if patient hypotensive in AKI?

Answer 30

Stop anti-hypertensives drugs

Question 31

What ECG changes are seen in hyperkalaemia?

Answer 31

Peaked T waves P wave widened and flatened PR segment lengthened

Question 32

What can hyperkalaemia cause?

Answer 32

VF/asystole Cardiac arrests Death

Question 33

When do you give dialysis in AKI?

Answer 33

Low carbonate High potassium Pulmonary oedema Pericarditis

Question 34

Where is haemodialysis given?

Answer 34

kidney unite