Y4 Acute Care > AKI > Flashcards

AKI Flashcards

(27 cards)

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1
Q

What are the NICE criteria that define AKI? (3 things)

A
  1. Creatinine rise of 25+ micromol/L in 48 hrs
  2. Creatinine rise of 50+% in 7 days
  3. Urine output of 0.5– ml/kg/hr for 6+ hrs

Any 1 of dem = AKI

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2
Q

What are the Risk Factors for AKI? (7 things)

A
  1. Age (65+)
  2. CKD
  3. HF
  4. DM
  5. Liver disease
  6. Nephrotoxic medications (NSAIDS / ACEi / ARBs / Diuretics like Spironolactone / Aminoglycosides)
  7. Iodinated contrast medium in CT scans
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3
Q

What are the 3 types of causes of AKI?

A
  1. Pre-renal
  2. Instrinsic
  3. Post-renal
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4
Q

What is the most common Type of cause of AKI?

A

Pre-renal

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5
Q

What are the Pre-Renal causes of AKI? (4 things)

A
  1. Reduced CO (Cardiogenic Shock / MI)
  2. Reduced blood volume (Haemorrhage / DnV / Pancreatitis)
  3. Systemic Vasodilation (Sepsis)
  4. Renal Vasoconstriction (NSAIDs / ACEi / ARBs)
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6
Q

What are the Instrinsic causes of AKI? (3 things)

A
  1. Glomerular (GN / ATN)
  2. Interstitial (Drug reaction / Inf)
  3. Vasculitis
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7
Q

What are the Post-Renal causes of AKI? (2 things)

A
  1. Within Renal Tract (Stone / Stricture / Clot / Cancer)
  2. Extrinsic Compression (Pelvic Cancer / BPH)
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8
Q

What are the CF of Pre-Renal AKI? (6 things)

A

Dehydration + Hypovolaemia:

  1. Postural hypotension
  2. Dizziness
  3. Thirst
  4. Prolonged cap refill
  5. Reduced skin turgor
  6. Reduced urine output
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9
Q

What are the CF of Intrinsic AKI? (6 things)

A
  1. Glomerular: Nephrotic / Nephritic Syndrome
  2. Interstitial (e.g Acute Interstitial Nephritis) : Fever / Arthralgia / Rashes / Eosinophilia
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10
Q

What are the CF of Post-Renal AKI? (8 things)

A
  1. Urinary Stones: Loin-groin pain / Haematuria / N+V
  2. BPH: Dysuria / Frequency / Dribbling
  3. Bladder Neck Obst: Palpable Bladder / Tender Suprapubic Area
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11
Q

What investigations should you do for sus AKI? (4 things)

A
  1. Urinalysis
  2. US / CXR / Renal Doppler / MRA
  3. ECG
  4. Bloods
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12
Q

What will results of Urinalysis suggest in sus AKI?

A
  1. Leucocytes / Nitrites = Inf
  2. Protein + Blood = Acute Nephritis / Positive Infection
  3. Glucose = Diabetes
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13
Q

What are you looking for in CT of sus AKI?

A

Obst uropathy (e.g. hydronephrosis)

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14
Q

What are you looking for in CXR of sus AKI?

A

Signs of fluid overload

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15
Q

What are you assessing in Renal Doppler of sus AKI?

A

Renal vascular assessment

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16
Q

What are you asessing in MRA (MR Angiography) of sus AKI?

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A

Renal vascular assessment

17
Q

What are the management options for AKI? (4 things)

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A
  1. Pre-Renal: IV Fluid rehydration
  2. Post-Renal: Relieve obst (e.g catheter for pt w retention bc enlarged prostate)
  3. Stop Nephrotoxic Meds (e.g ACEi / NSAIDs / Spironolactone)
  4. Manage complications
  5. Renal Replacement Therapy
18
Q

What are the complications of AKI? (4 things)

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A
  1. Hyperkalaemia
  2. Metabolic acidosis
  3. Fluid overload / HF / Pulmonary Oedema
  4. Uraemia –> Encephalopathy / Pericarditis
19
Q

What will you see on a ECG of Hyperkalaemia? (4 things)

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A
  1. Small / Absent P wave
  2. Increased PR interval
  3. Widened QRS complex
  4. Tall “tented” T waves
20
Q

Why is Hyperkalaemia important to know about?

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A

MEDICAL EMERGENCY

21
Q

What are the management options for Hyperkalaemia? (3 things)

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A
  1. Calcium gluconate: Protects myocardium
  2. Insulin / Salbutamol (Beta Agonist): Drives Potassium back into intracellular compartment
  3. Stop Potassium Sparing / Containing meds (e.g Spironolactone)
22
Q

Why does Metabolic Acidosis occur in AKI?

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A

Bc kidney responsible for Acid-Base balance but impaired in AKI

23
Q

What are the management options for Metabolic Acidosis? (2 things)

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A
  1. Sodium bicarbonate
  2. Dialysis
24
Q

What causes Fluid Overload in AKI? (3 things)

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A
  1. Aggressive Fluid resus treatment
  2. Oliguria
  3. Sepsis (bc increased capillary permeability)
25
What are the management options for Fluid Overload? (4 things)
1. Oxygen if needed 2. Fluid restriction 3. Diuretics (only if symptomatic) (careful bc nephrotoxic) 4. Renal Replacement Therapy
26
What are the indications for Renal Replacement Therapy in AKI?
All 4 AKI complications not responding to meds
27
What are the complications of Renal Replacement Therapy? (3 things)
1. Procecdural Hypotension 2. Bleeding bc need anticoag req 3. Altered drug clearance
Y4 Acute Care
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