Session 10 - Acute Kidney Injury Flashcards Preview

Semester 3 - Urinary > Session 10 - Acute Kidney Injury > Flashcards

Flashcards in Session 10 - Acute Kidney Injury Deck (59)
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1

What is Oliguria?

• Little urine
• Less than 500ml of urine/day or less than 20ml/hour

2

What is anuria?

• No urine
• Less than 100ml of urine/day
• Indicates blockage of urine flow

3

Give three causes of acute kidney injury

• Pre-renal disease
○ Decreased perfusion
• Post-renal failure
○ Obstruction
• Intrinsic Renal Failure
○ Dame to kidney

4

What is pre-renal acute kidney injury caused by?

• A reduction in renal perfusion
• If not treated promptly acute tublar necrosis will develop

5

Give two over arching causes of pre-renal AKI

• Reduced effect ECF volume

Impaired renal autoregulation

6

Give three overarching causes of reduced effective ECF volume

• Hypovolaemia
• Systemic vasodilation
• Cardiac failue

7

Give two causes of hypovolaemia

• Blood loss
• Fluid loss

8

Give three causes of systemic vasodilation

• Sepsis
• Cirrhosis
• Anaphylaxis

9

Give three causes of cardiac failure

• LV dysfunction
• Valve disease

Tamponade

10

Give two causes of impaired renal autoregulation

• Preglomerular vasoconstriction
• Postglomerular vasodilation

11

Give four causes of preglomerular vasoconstriction

• Sepsis
• Hypercalcaemia
• Hepatorenal syndrome
• Drugs - NSAIDS

12

Give two causes of post glomerular vasodilation

• ACE inhibitors
• Angiotensin 2 antagonists

13

What is post renal AKI?

• Injury as a result urine flow obstruction

14

What are the three sites at which urine flow can be blocked, causing post renal AKI?

• Ureters
• Bladder
• Urethra

15

What are three places obstructions can be at each particular site in post renal AKI?

• Within the lumen
• Within the wall
• Pressure from outside

16

Give four causes of blockage within the wall of the ureter, bladder or urethra

• Calculi
• Blood clot
• Papillary necrosis
• Tumour of renal pelvis, ureter or bladder

17

How large must a calculi be to stop it passing?

>10mm

18

Give two causes of obstruction within the wall of the ureter, bladder or urethra

• Congenital
• Ureteric stricture

19

What does obstruction with the wall of the ureter, bladder or urethra usually cause other than acute post renal AKI?

Chronic kidney injury

20

Give three congenital causes of obstruction within the wall of the ureter, bladder or urethra

• Pelviureterteric neuromuscular dysfunction
• Megaureter
• Neurogenic bladder

21

Give five causes of pressure from outside causng post-renal AKI

• Prostatic hypertrophy
• Malignancy
• Aortic aneurysm
• Diverticulitis
• Accidental ligation of ureter

22

Give three causes of intrinsic AKI

• Acute tubular necrosis
• Glomerular and arteriolar disease
• Acute tubule-interstitial

23

What are the two main causes of acute tubular necrosis?

• Severe acute ischaemia
• Toxic acute tubular necrosis

24

What is severe acute ischaemia caused by?

• Pre-renal fall in perfusion, causing tubular necrosis

25

What is toxic acute tubular necrosis?

• Nephrotoxins damage the epithelial cells lining the tubules and cause cell death
• Nephrotoxins can be endogenous or exogenous

26

What is the most common cause of acute tubular necrosis?

• Where there is toxic acute tubular necrosis AND severe acute iscaemia

27

Name three endogenous nephrotoxins

BUM
• Bilirubin
• Urate
• Myoglobin

28

Give four exogenous causes of ATN

• Endotoxin
• X-ray contrast
• Drugs
• Other poisons

29

Give three main drugs which are exogenous nephrotoxins

• ACE inhibitors
• NSAIDs
• Aminoglycosides

30

How are NSAIDs toxic to the kidney?

• Prostaglandins usually causes vasodilation of afferent arterioles in renal autoregulation
• NSAIDs inhibit prostaglandin production by inhibition of COX
• Unopposed vasoconstriction of afferent arteriole occurs -> Reduced glomerular perfusion pressure -> AKI