AKI

Question 1

AKI

What is an AKI characterised by?

Answer 1

a decline in renal excretory function over hours or days that can result in failure to maintain fluid, electrolyte, and acid-base homeostasis

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Question 2

AKI

What are the 3 categories of causes for AKIs?
Name 3 in each category.

Answer 2

Prerenal (the BODY is in extreme shock)
*major haemorrhage, burns, hypotension, renal hypofusion (iatrogenic), nephrotic syndrome

Intrinsic (very rare, the KIDNEYS are injured)
* glomerular
*glomerulonephritis,

• tubular
  *acute tubular necrosis
• interstitial
  *acute interstitial nephritis
• vascular
  *vasculitis, renal artery stenosis, renal vein thrombosis, malignant hypertension
• eclampsia

Postrenal (UROLOGICAL cause)
* obstruction of any sort
*BPH, stones, stricture, cancer

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Question 3

AKI

Name some risk factors for developing an AKI.

Answer 3

• CKD, HF, liver disease
• History of AKI, oliguria
• Drugs - NSAIDs, ACEi, diuretics
• obstructions
• sepsis
• age >65yo

Question 4

AKI

How would a pt present? (Symptoms)

Answer 4

• urine output: oliguria/anuria
• nausea, vomitting
• dehydration
• confusion

Question 5

AKI

How would a pt present? (Signs)

Answer 5

• pallor, rash, bruising
• hypertension
• dehydration or fluid overload w/ raised JVP
• pericardial rub
• large painless bladder

Question 6

AKI

What bloods would you want to do for a pt with suspected AKI?

Answer 6

• FBC / blood film
• U&Es + creatinine
• coagulation studies
• creatine kinase, myoglobinuria
• CRP
• immunology (ANA for lupus)

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Question 7

AKI

What investigations would you want to do for a pt with suspected AKI?

Answer 7

• urinalysis (dipstick + osmolality)
• bloods
• USS
• other radiology

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Question 8

AKI

Name 3 differentials.

Answer 8

• CKD
• acute on chronic kindey disease
• sepsis

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Question 9

AKI

How is it staged?

Answer 9

Acute kidney disease staging according to the Kidney Disease: Improving Global Outcomes classification:

Stage 1:
Serum creatinine levels: 1.5-1.9-fold higher than baseline or increase ≥ 3 mg/L.
Urine output <0.5 ml/kg/hr for 6-12 hrs.

Stage 2:
Serum creatinine levels: 2-2.9-fold higher than baseline.
Urine output <0.5 ml/kg/hr for ≥12 hrs.

Stage 3:
Serum creatinine levels: 3-fold higher than baseline or increase ≥40 mg/L, or initiation of renal replacement therapy.
Urine output <0.3 ml/kg/hr for ≥24 hrs or anuria for ≥12 hrs.

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Question 10

AKI

How to manage? (pre-renal)

Answer 10

• Get the fluid balance right
• Fluids if underfilled
• Offload if over filled – GTN and furosemide

Question 11

AKI

How to manage? (intrinsic)

Answer 11

stop toxic agents
- NSAIDS
- Gentamicin
- ACEi/ARBS
- contrast

Question 12

AKI

How to manage? (postrenal)

Answer 12

treat cause of obstruction

Question 13

AKI

Indications to do a biopsy

Answer 13

• unexplained kidney injury with normal kidney size
• histology is likely to influence treatment
• histology is likely to offer prognostic info
• info concerning activity (and potential reversing) of previously identified lesion would be useful

Question 14

AKI

Complete the acronym for pathologic basis of disease.
GDIIITTTNN

Answer 14

Question 15

AKI

Describe the prognosis:
* overall prognosis
* what improves prognosis
* long term effects
* community vs hospital acquired

Answer 15

• poor
• early detection improves
• increased risk of aki again
• CA better than HA

Question 16

AKI

Risk of biopsy.

Answer 16

• bleeding
• pain
• incorrect tissue obtained
• colonic perforation