Acute Kidney injuries Flashcards
What is acute kidney injury?
Abrupt deterioration of kidney function - usually over hours or days
Give the diagnostic definition of abrupt kidney injury
Rising Serum creatinine:
- by ≥ 26.5 μmol/l (0.3 mg/dl ) within 48 hours
- or to ≥ 1.5x baseline (which is about 80)
OR
Oliguria:
- Urine volume <0.5 ml/kg/h for 6 hours
What are the immediately dangerous consequences of AKI?
Think AEIOU
Acidosis
Electrolyte imbalance
Intoxication (toxins)
Fluid Overload
Uraemic complications
What are the pre-renal causes of AKI?
Cardiac failure
Haemorrhage
Sepsis
Vomiting & diarrhoea
What are the intrinsic renal causes of AKI?
Glomerulonephritis
Vasculitis
Radiocontrast (iodine)
Myeloma
Rhabdomyolysis
Drugs (NSAIDs, Gentamicin, radiocontrast)
What are the post-renal causes of AKI?
Urinary tract obstructions…
- Stones (calculi)
- Tumours
- Prostate disease
What are the risk factors for an acute kidney injury?
> 75
Previous AKI
Chronic kidney disease (acute-on-chronic)
Heart failure
Liver disease
Diabetes
Vascular disease
cognitive impairment
What are risk events for AKI?
Sepsis - eg pneumonia, cellulitis
Toxins - NSAIDs, gentamicin, radiocontrast etc
Hypovolaemia - haemorrhage, vomiting, diarrhoea
Hypotension - relative to baseline blood pressure
Major surgery
The prevention of AKI is more preferable than to its treatment
Describe the approach to preventing AKI in an at risk patient
If patient has risk factors and has had an AKI risk event - then consider the STOP approach
Sepsis - if suspected then screen & treat
Toxins - avoid usage of NSAIDs, gentamicin, radioC
Optimise BP and blood volume
Prevent harm - daily U&Es, fluid balance & meds review
How is Sepsis managed to prevent it from causing AKIs?
Sepsis 6 - 3 in, 3 out
3 out:
- blood cultures
- urine output and U&Es
- Lactate
3 in:
- IV antibiotics
- IV fluids
- Oxygen
In avoiding an acute kidney injury - how are blood pressure and volume optimised?
If hypovolaemic:
- IV crystalloid fluid over 15 mins
If hypotensive:
- Consider withholding anti-hypertensives and diuretics
Following a diagnosis of AKI - what is the immediate management for a patient?
Assess and correct volume status
Correct Hypovolaemia:
- IV fluids
- Continue until euvolaemic then treat as that
Once Euvolaemic:
- Oral or IV maintenance fluid
If progresses to Hypervolaemia:
- If fluid overload - but still oliguric - Refer to big boi consultant
A patient has been diagnosed with AKI - and has had their volume status assessed and corrected
What is the next stage of their management?
AKI Response - SHOUT
S - Sepsis - treat it fam
H - Hypovolaemia - treat it fam
O - Obstruction - Consider bladder scan and/or US
U - Urinalysis - Ensure urinalysis is performed and documented
T - Toxins - Stop/avoid toxins (gentamicin, NSAIDs etc)
A patient has been diagnosed with Acute kidney injury and is in the receiving ward of a hospital
What are the indications that they should be referred to Renal?
Persistent oliguria or ongoing deterioration
Persistent Hyperkalaemia
Persistent pulmonary oedema
Severe metabolic acidosis
Suspicion of intrinsic renal disease (eg vasculitis)
AKI with low platelets
AKI stage 3 (ie really bad AKI)
What are the investigations for Acute kidney injuries?
Renal function tests:
- Creatinine, U&Es, Bicarb, LFTs
FBC
Urine dipstick
Clotting screen
USS
What ECG changes are present in Hyperkalaemia?
Tall tented T waves - often the first sign of Hyperkalaemia (shown in photo)
Then:
- P wave widens and flattens
- PR segment lengthens
- P waves eventually disappear
however - can progress into AV block n stuff as well
