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Yr3 Met 3B > 5. Acute Kidney Injury > Flashcards

5. Acute Kidney Injury Flashcards

1
Q

What is the clinical definition of Acute Kidney Injury?

A

Rapid reduction in Kidney function (hours to days) characterised by High Creatinine and/or Low Urine output

  1. Rise in Serum Creatinine of > 26 umol/L in 48 hours

OR

  1. 1.5-1.9 x Increase in Serum Creatinine known to have happened in the last 7 days

OR

  1. 6 hours of Oliguria (Urine Output of <0.5 ml/kg/hour)
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2
Q

What patients are at risk of getting AKI?

A
  1. Elderly
  2. CKD (eGFR < 60ml/min/1.73 m^2)
  3. Cardiac Disease
  4. Liver Disease
  5. Diabetes
  6. Vascular Disease
  7. Nephrotoxic Medication
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3
Q

What is the Main Acronym to manage AKI?

A

Sepsis: Find the infection (if there is one) and treat it
Toxicity: Avoid medications that harm the Kidneys
Optimising BP
Parenchymal Disease

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4
Q

What are the 4Ms to prevent AKI?

A
  1. Monitor (BP/Fluids/Blood)
  2. Maintain circulation (Hydration/Resus/Oxygenation)
  3. Minimise Renal Insults
    - Nephrotoxic meds
    - Iodinated Contrast
    - HAIs
  4. Manage acute illnesses appropriately
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5
Q

How do we maintain fluids in AKI?

A

Assess the volume status (Standing/Supine)

  • HR
  • JVP
  • Cap Refill
  • Conscious Level
  • Lactate
  • Weight

If they are HypoVol, give bolus fluids (250-500 ml) and review

If 2+ Litres are given and underperfused, give circulatory support

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6
Q

Why is too much fluid harmful in AKI?

A

Pulmonary oedema

Delayed recovery

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7
Q

For a euvolemic patient with AKI, how should you manage them?

A

Give maintenance fluids: Estimated Daily output + 500 mL

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8
Q

What fluids are best suited for AKI patients?

A

Isotonic Fluids (Plasmalyte/Hartmann’s): Containing Potassium (5 mmol/L)

0.9% Saline: But can worsen Metabolic Acidosis if large volumes used

Colloids: High molecular weight starches (HES)
- Dextran can worsen AKI

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9
Q

How do we monitor and Manage AKI?

A
  1. Urinary Catheter + Hourly input/output
  2. U+Es, Bone Profile, Venous Bicarbonate
  3. Blood Gases
  4. Lactate
  5. Regular Fluid assessment
  6. Daily weights
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10
Q

How do we investigate AKI?

A
  1. Urine Dip (PCR if protein is present)
  2. US Scan < 24 hours
    - 6 hours if Pyonephrosis is suspected
  3. Inflam Markers (CK/LFTs)
  4. Blood Film/LDH/Reticulocyte count
  5. HUS/TTP/Acc HTN with MAHA
    - If Platelets are low
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11
Q

What 8 things can be investigated in AKI in the blood?

A
  1. Serum protein electrophoresis/Bence Jones Protein (Myeloma)
  2. Blood and Protein +++ on dip
  3. HIV/HCV/IgG/HepB
  4. ANCA
  5. Anti-GMB
  6. Complements
  7. Rheumatoid Factor
  8. ANA/ENAs
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12
Q

What does the Bence Jones Protein indicate in the urine?

A

Multiple Myeloma

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13
Q

If there is blood and protein +++ on dip, what can be suspected?

A

Acute Glomerulonephritis

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14
Q

What do we do whilst supporting AKI recovery?

A
  1. Treat Sepsis
  2. Maintains Perfusion
  3. Stop NSAIDs, ACE, ARB, Metformin, PSD/Adjust drug doses
  4. Stop antihypertensives if hypotensive
  5. Minimise iodinated contrast
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15
Q

Why is Calcium gluconate given to AKI patients?

A

If their ECG changes and to reduce the risk of Myocardial Arrhythmias

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16
Q

Why is IV Insulin or Dextrose given to AKI patients?

A

10 Units Insulin or 50 mL of 50% Dextrose can promote Potassium shift into ICS

  • Given if Potassium is above 6.5 mmol/L
  • Sometimes Na2CO3 is given
17
Q

Why do we given 1.26% bicarbonate IV 500 ml 1-4 hours to AKI patients?

A

If their Bicarbonate is below 22 mmol/L

18
Q

If an AKI patient has their whole body potassium lowered, what do they need?

A

Kidney recovery of function
Renal Replacement therapy
- Haemodialysis
- Filtration

19
Q

How can we manage Pulmonary Oedema as a result of AKI?

A
  1. Sit them up and give O2
  2. GTN Infusion
  3. Furosemide
    - >80 mg bolus (then further)
    - 10mg/hr infusion
20
Q

How can we manage Acidosis as a result of AKI?

A
  1. Ensure it is renal in origin
  2. Recovery of renal function
  3. Critical Care referral if pH drops below 7.15
  4. Renal Replacement Therapy maybe
21
Q

How can we confirm if acidosis is renal in origin?

A
  1. Raised Anion gap
  2. Gases
  3. Lactate
  4. Ketones
22
Q

How do we refer AKI patients with an Obstruction?

A

Urology/Interventional Radiology for Nephrostomy +/- Stenting

23
Q

How do we refer AKI patients with blood/protein on dip/Autoimmune diseases

A

Renal (Local or Regional)

24
Q

How do we refer AKI patients progression into Stage 3 (Creatinine 3x above baseline and rise of 354 umol/L, 12 hours of Anuria?)

A

Local Renal for HD

Regional if they are safe to transfer

25
Q

How do we refer AKI patients if they have 1 organ failure/unstable/acute HD unavailable and they are unsafe to travel?

A

ICU for CVVHF

26
Q

What does CVVHF stand for?

A

Continuous Veno-venous Haemofiltration

Yr3 Met 3B (13 decks)

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