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level: Acute Kidney Injury (L10)

Questions and Answers List

level questions: Acute Kidney Injury (L10)

QuestionAnswer
AKI definitionAKI is defined as any one of the following: Increase in Serum Creatinine by 26.5 μmol/l within 48 hours or Increase in Serum Creatinine to ≥ 1.5 times baseline, known/presumed to have occurred within the prior 7 days or Urine volume < 0.5 ml/kg/h for 6 hours.
Risk factors for AKIAge Diabetes immunosuppression polypharmacy dehydration infection CKD Renal stones BPH
Classification of AKIStage 1: 1.5-1.9 times baseline serum creatinine, urine output of less than 0.5 ml/kg/h for 6-12 hours Stage 2: 2-2.9 times baseline serum creatinine, urine output of less than 0.5 ml/kg/h for 12 hours or greater Stage 3: 3times baseline serum creatinine, urine output of less than 0.3 ml/kg/h for 24 hours or greater or anuria for 12 hours or more
Causes of Prerenal AKIHypovolemia Decreased Cardiac Output Decreased Effective circulating volume (caused by CHF and liver failure) Impaired Renal Autoregulation (caused by NSAIDS, Angiotensin receptor Blockers, ACE inhibitors, Cyclosporine)
Drug induced Pre-renal AKI pathophysiologyDecreased Renal blood flow -> leads to increase in vasodilating prostaglandins to dilate the afferent arteriole. Blunted by NSAIDS that inhibit prostaglandin production Decreased Renal blood flow-> leads to Angiotensin 2 constricting the efferent arteriole. Blunted by ACE inhibitors/ARBs that inhibit angiotensin 2 production Both processes overcome by sever hypovolaemia
Intrinsic Renal AKI causesAcute Glomerulonephritis Tubular Damage (caused by Ischaemia, Sepsis, Nephrotoxins) Vascular (caused by Vasculitis, thrombotic thrombocytopenic purpura/Hemolytic uremic syndrome, Malignant hypertension)
Glomerular diseases (Nephrotic vs Nephritic)Nephrotic Injury to podocytes Changed architecture: Scarring, Deposition of matrix or other elements Proteinuria Nephritic Inflammation Reactive cell proliferation Breaks in GBM Crescent formation Haematuria
Postrenal AKI causesBilateral uretopelvic obstruction Bladder outlet obstruction
AKI signs and symptomsNausea and lethargy Decreased urine output Fluid overload Electrolyte abnormalities Acid base disturbance
Risk factors for AKIAge 65+ CKD Cardiac Failure Liver disease Diabetes Vascular disease Nephrotoxic medications ACUTE 'STOP' Sepsis and hypoperfusion Toxicity Obstruction Parenchymal kidney disease
AKI PreventionMonitor patient Maintain circulation Minimise kidney insults Manage the acute illness