6.2 AKI Flashcards
uraemia aetiology
nitrigenous metabolic waste products accumulate in blood (urea and creatinine) due to decreased filtration of these products by kidneys
changes seen in urine output in AKI
oliguria anuria
how is AKI staged?
the most severe outcome of staging via
-urine output
-blood creatinine
how does sepsis cause pre renal AKI?
endotoxin release = vasoconstriction = decreases circulating vol so less blood perfuses kidney, less filtration so creatinine and urea rise in blood
how does renal artery stenosis cause pre renal AKI?
athersclerosis of renal artery decreases blood flow to kidney
how do NSAIDs cause pre renal AKI?
NSAIDs decrease prostaglandins so can’t compensate for systemic vasoconstriction so can’t increase blood flow to kidney
causes of intrinsic renal AKI
-vasculitis
-acute tubular necrosis
-rhabdomyolysis
-acute interstitial nephritis: drugs, disease, lupus
-glomerular disease: kidney can’t filter
what’s hydronephrosis?
obstrctution prevents urine getting past so urine collects and distends, firstly get hydrometer then hydronephrosis
what could cause urethral/ureteric strictures to cause post renal AKI?
stone removal, scarring
narrows ureter
how can BPH cause AKI?
compresses prostatic urethra so causes post renal AKI
what to check in assessment of fluid status
general: colour, RR, dialysis machines
peripheral: hand temp, skin turgor, HR, BP, postural BP
face/neck: sunken eyes, mucous membranes, JVP
check/back: percussion, crepitations, oedema
abdo/limbs: ascites, ballotable kidneys, palpable bladder, urine output
4 complications of AKI
- metabolic acidosis
- hyperkalaeamia
- volume overload
- uraemia- nitrogenous compounds in blood
nephrostogram
x ray checks urine flow through catheter
management of pre renal AKI
-IV fluids
-hold off any nephrotoxic meds e.g. NSAIDs/ACEi
-diuretics if need
management of intrinsic renal AKI
-correct electrolytes
-renal replacement therapy (dialysis)
-nephrology team
