Flashcards in Week 227 - Acute Kidney Injury Deck (16)
What is rhabdomyolysis?
Skeletal muscle breakdown/necrosis secondary to injury
Releasing intracellular constituents into the circulation
MUST be treated early - can be life threatening due to kidney failure
Give some potential causes of rhabdomyolysis
Traumatic accident (could include severe muscle strain)
Alcohol or illicit drug use e.g. Cocaine, heroin, amphetamines
Medications e.g. Statins or antipsychotics
Name the 3 overarching causes/categories of Acute Renal Failure
List causes of pre-renal AKI and describe briefly the main pathology involved
> due to disturbance in renal blood supply
- Reduced BP / volume
- heart failure
- renal artery stenosis or renal vein thrombosis
List causes of renal/intrinsic AKI and describe briefly the main pathology involved
> Damage to parenchyma of the kidney
- Acute Tubular Necrosis (ATN)
- Acute Interstitial Nephritis (AIN)
List causes of post-renal AKI and describe briefly the main pathology involved
> Usually consequence of urinary tract obstruction
- Renal stones / Bladder stones
- Obstructed urinary catheter
What are the signs and symptoms of rhabdomyolysis?
Fever and tachycardia
Confusion / dehydration / reduced consciousness
Dark red or brown urine / reduced or no urine output
What are the two main types of investigation you should perform with suspected rhabdomyolysis? Why?
- Blood tests for: creatinine kinase, potassium, phosphate, urea, calcium levels
- Urinalysis: colour, output, microscopy (for RBCs)
To assess for rhabdomyolysis induced AKI
What results might you expect to see from blood tests and urinalysis in a pt with rhabdomyolysis induced AKI?
Bloods: Raised creatinine kinase, potassium, phosphate, urea
Reduced calcium (enters the muscle)
Urine: dark brown/red (myoglobin), blood on dipstick WITHOUT blood RBCs on microscopy
What is the management for rhabdomyolysis?
IV fluids to improve urine output and prevent renal failure
Electrolyte correction (potassium, phosphate, calcium)
Treat underlying cause
What are urinary casts?
Cylindrical structures formed in the distal convoluted tubules and collecting ducts if the kidneys, which dislodge and pass into the urine in certain disease states
Name the various types of cast you may see in urinalysis (microscopy)
Fatty; Granular; Hyaline; Red blood cell; Renal tubular epithelial cell; Waxy and White blood cell casts
List a reason for the presence of the following:
- RBC casts
- WBC casts
- Fatty casts
- Hyaline casts
- RBC casts: bleeding into the kidney
- WBC casts: acute kidney infection
- Fatty casts: (ppl w/lipids in urine) complication of nephrotic syndrome
- Hyaline casts: dehydration, exercise or diuretic medications
How can you prevent rhabdomyolysis induced AKI?
1. Forced alkaline diuresis (with sodium bicarbonate)
2. Mannitol "Forced Diuresis"
What is the definition of diuresis?
Increasing production of urine