Return to Scenario ListShow Learning Points most relevant to Phase 1:

Acute kidney injury

Clinical Discipline(s)/Organ System(s)
Genitourinary System, Renal Medicine, General Surgery
Progress Test Topic(s)
A 65 year old NZ European man who was admitted to the Surgical High Dependency Unit after an emergency repair of his abdominal aortic aneurysm (AAA) is noted to be passing only small amounts of urine. He has a history of hypertension and type 2 diabetes.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Structure and function of the renal tract
   - Physiology of renal perfusion, ultrafiltration and the nephron
   - Definition and mechanisms of acute kidney injury; pathology of acute renal failure: prerenal, renal, postrenal
   - Pathology of diabetic renal disease
   - Effects of hypertension on the kidney
   - Pathology of abdominal aortic aneurysm (AAA)
   - Normal fluid balance and controls of kidney blood supply: renin-angiotensin-aldosterone system and prostaglandins
   - Principles of dialysis and haemofiltration
Clinical and Communication Skills 
   - History from the patient and a collateral history from family/whānau and staff involved in care
   - Focused examination relevant to the presentation of oliguria including aspects of cardiovascular, fluid status/hydration and abdominal examination
   - Use of urinary catheter, cystoscopy, lithotripsy and nephrostomies in obstructive uropathy; complications of procedures
   - Perform urinary catheterisation
   - Causes of acute oliguric renal failure
   - Contribution of nephrotoxic medications (e.g. non-steroidal anti-inflammatory drugs and contrast media) to acute kidney injury
   - Define nephrotic and nephritic syndromes; list common causes
   - Indications for renal and bladder ultrasound
   - Interpret urine dipstick, renal function blood tests and acid-base status, urine and plasma osmolality and sodium
   - Emergency management of hyperkalaemia
   - Indications for haemofiltration/haemodialysis in acute renal failure
   - Cause and management of a post-obstructive/acute tubular necrosis diuresis
   - Prognosis of acute kidney injury
Personal and Professional Skills 
   - Reflect on perceptions of iatrogenesis
   - Culturally respectful examination
Hauora Māori 
   - Communication with patient and whānau (e.g. running a whānau meeting) in a setting of iatrogenesis
   - Differing risk profile for Māori (co-morbidities) for renal disease
Population Health 
   - Epidemiology of abdominal aortic aneurysm (AAA): age, gender, prevalence, screening
Conditions to be considered relating to this scenario
hypovolaemia, acute tubular necrosis, drug-induced, renal calculi, benign prostatic hypertrophy, cardiac failure, acute interstitial nephritis
Less common but 'important not to miss'
external compression of ureters, antineutrophil cytoplasm antibody (ANCA) vasculitis, systemic lupus erythematosus (SLE), prostate cancer, Goodpasture's syndrome, sepsis
retroperitoneal fibrosis, focal segmental glomerulosclerosis, minimal change disease, membranous nephropathy, IgA nephropathy
Related Scenarios
[AAA screening]