Urology Flashcards
how do you define an AKI and what are the stages based on those criteria
- raised creatinine and low urine output
- stage I is creatinine x1.5, urine output <0.5ml/kg/h for 6-12 hrs
- stage II is creatinine x2, urine for more than 12 hrs
- stage III is creatinine x3, urine for 24hrs
what are 3 pre-renal causes of an AKI
kidney hypoperfusion due to
- hypovolaemia (bleeding)
- low cardiac output (heart failure)
- vasodilation (sepsis)
what are 5 renal causes of an AKI
structural issues
- tubular (acute tubular necrosis)
- interstitial (acute interstitial necrosis)
- glomerulonephritis
- vascular (HUS, TTP)
- drugs (ACEi, ARB, NSAIDs)
what are 2 causes of acute tubular necrosis
- ischaemia
- nephrotoxins: NSAIDs, rhabdomyolysis
what are 2 investigations of acute tubular necrosis
- U&Es: high urea & creatinine (normal ratio), hyperkalaemia
- urinalysis: muddy brown casts
how to manage acute tubular necrosis
- strictly monitor urine output
- IV fluids (poor response)
how does acute tubular necrosis present
diuresis
what causes acute interstitial necrosis
drug allergy (penicillin)
how does acute interstitial necrosis present
- fever
- arthralgia
- rash
what are 2 investigations for acute interstitial necrosis
- FBC: eosinophilia
- urinalysis: white cell casts
what are 4 features of HUS
- AKI
- haemolysis
- thrombocytopenia
- bloody diarrhoea & abdo pain
what would you see in a stool culture for HUS
- Shiga toxins
how do you manage HUS
- supportive: fluids + transfusion
what are 3 post-renal causes of an AKI
obstruction due to
- stones
- cancer
- BPH
what are the steps to investigating an AKI
i) assess fluid status
ii) get a drug history
iii) bedside: ECG, urine dip, stool culture
iv) bloods
v) imaging: US if post-renal
