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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31

Why are ACE inhibitors exogenous nephrotoxins?

• Angiotensin II has a key role in homeostatic control of kidney blood flow
• Efferent arteriole constriction
• ACE inhibtors remove this effect, decreasing GFR

32

What will you see in Acute Tubular Necrosis?

• Muddy brown casts in urine
• Fractional excretion of Na+ >3%

33

How do you calculate fractional excretion of Na?

• (Na (urine) x Cr (plasma)/Cr (urine) x Na (plasma) ) x 100

34

Give two types of glomerular and arteriolar disease

• Primary acute glomerulonephritis
• Secondary acute glomeurlonephritis

35

What is acute glomerulonephritis?

• Immune disease affecting glomerulus (See session 9)

36

Give two causes of secondary acute glomerulonephritis?

• Systemic lupus erthyrematosus

Vasculitis

37

What is acute tubulo-interstitial nephritis? Give two causes

• Inflammation of the kidney intersitium
• Acute pyelonephritis and drugs

38

What are the three questions that should be asked when treating a patient with AKI?

• Are the kidneys underperfused? Pre-renal injury
• Are nephrotoxins implicated? Direct renal injury
• Is there a renal tract obstruction? Post-renal injury

39

If kidneys are underperfused, what are two main causes?

• Shock
• Severe vascular disease

40

What are the three main types of shock?

• Hypovoleamic
• Septic
• Cardiac

41

What is the main cause of severe vascular disease causing AKI?

Emboli

42

What are three main possible nephrotoxins in direct renal injury?

• Drugs
• Sepsis (endotoxins)
• Myoglobin

43

What is one disease you can NEVER forget which also causes direct renal injury?

• UTI progressing to pyelonephritis

44

Give five signs of cardiac failure

• Gallop rhythm
• Raised BP
• Raised JVP
• Pulmonary oedema – Basal crackles and dyspnoea
• Peripheral oedema (Sacral/ankle)

45

Give five signs of sepsis

• Pyrexia and rigors
• Vasodilation, warm peripheries
• Bounding pulse
• Rapid capillary refill

Hypotension

46

Give six signs of a urinary tract obstruction

• Anuria
• Single functioning kidney
• History of renal stones, prostatism or previous pelvic/abdominal surgery
• Palpable bladder
• Pelvic/abdominal masses
• Enlarged prostate (DRE)

47

What signs will you see in ALL AKI?

• Increased serum urea and creatinine
• Hyperkalaemia
• Hyponatraemia
• Hypocalcaemia
• Hypophosphataemia

48

What investigations are peformed in AKI?

• ECG
• Urine tests - Dipstick and microscopy
• Soluble immunological tests
• Imaging
• Biopsy

49

What ECG changes will you see in hyperkalaemia?

• Tall T waves
• Small/Absent P waves
• Increase P-R interval
• Wide QRS complex
• ‘sine wave’ pattern

Asystole

50

What do you look for in dipstick tests?

• Blood
• Protein
• Leucocytes

51

Will there be proteinuria/haematuria/any abnormal microscopy in the urine of someone with PRE-RENAL AKI?

• No proteinuria
• No haematuria
• Hyaline cast in urine - Aggregations of protein seen in concentrated urine (normal sign, but will be present on every urination)

52

Will there be proteinuria/haematuria/any abnormal microscopy in the urine of someone with ACUTE TUBULAR NECROSIS

• No proteinuria
• No haematuria
• Muddy brown casts in urine

53

Will there be proteinuria/haematuria/any abnormal microscopy in the urine of someone with

GLOMERULONEPHRITIS?

• Heavy proteinuria
• Heavy haematuria
• RBC casts

54

What soluble immunological tests can you do in AKI?

• Look for ANA (anti-nuclear antibody)
○ Indication for SLE
• Look for ANCA (anti-neutrophil cytoplasmic antibody (ANCA)
○ Systemic vasculitis
• Look for anti-glomerular basement membrane antibodies

Goodpasture's disease

55

What are two imagine techniques used in AKI?

• Ultrasound
○ Renal size
○ Hydronephrosis
○ Presence of obstruction
• Chest X-ray
○ Pulmonary oedema

56

What is the treatment for pre-renal AKI

• Volume correction
○ Hypovolaemia -> Fluids
○ Heart failure -> Diuretic

57

What is the treatment for post-renal failure?

• Urological intervention to re-establish urine flow

58

What is the treatment for acute tubular necrosis

• Maintain good kidney perfusion

Avoid nephrotoxins

59

When is dialysis indicated?

When kidneys can no longer adequately excrete salt, water and potassium