Acute Kidney Injury Flashcards
How is an Acute Kidney Injury defined?
An increase in creatinine:
>26.5 umol/l for 48 hrs
1.5x baseline for 7 days
How many stages of AKI are there?
3
What are the stages of AKI
AKI 1
AKI 2
AKI 3
Define AKI 1
Serum creatinine 1.5-1.9 x increases or >26.5 umol.l
MOST COMMON
Define AKI 2
2.0-2.9x baseline
Define AKI 3
3.0 x baseline
What are the immediate dangers for life of an AKI 3
Acidosis Electrolyte imbalance Intoxication (lithium) Overload Uraemic complications - uraemic pericarditis -Encephalopathic
Is creatinine reabsorbed by the kidney ?
No
it is only increased in the blood due to a reduced GFR f
What are the categories of aetiology for AKI
Prerenal
Post-renal
Intrinsic
What are the pre-renal causes of AKI
Anything that causes hypoperfusion to kidney Cardiac failure Haemmorhage Sepsis Vomitting and Diarrhoea Hypovolaemia
What are the post-renal causes of AKI
Anything delaying/obstructing the normal flow of urine
Tumours - Lymphoma (compresses both ureters)
Prostate disease - BPH
Stones
What are the intrinsic causes of AKI (x6)
Glomerulonephritis Vasculitis Radiocontrast Myeloma Rhabdomyalosis Drugs
What drugs can causes an intrinsic AKI
NSIADS
Gentomycin
What is the rare aetiology of AKI
Intrinsic AKI
What are risk events of AKI
Sepsis Toxin (x-ray contrast, NSAIDS, gentamicin) Hypotension Hypovolaemia Major surgery
When do you activate the the STOP AKI prevention care bundle
When there is 1 or more risk factors
What is the STOP AKI prevention bundle
Sepsis (if suspec screen and treat)
Toxin (avoid toxins)
Optimise BP volume status (avoid incorrect medication)
Prevent Harm - daily U and Es, fluid balance and medication review
If patients that take medication are off sick with vomitting/diarrhoea what should they be told to help prevent AKI
Stop taking medications for 24-48hrs
What are the medicines to stop on sick days (x5)
ACE inhibitors ARBS NSAIDS Diuretics Metformin
On examination of patients with AKI what could you expect to find?
Axillary arm pit dryness
Palpable bladder
What should you do if you can palpate patients bladder
insert catheter
If you suspect an AKI what should the process be to treat
SHOUT
Suspect sepsis Hypovoleamia - assess volume status Obstruction - consider bladder scan/ultrasound Urinalysis - ensure its performed Toxins - consider stopping toxins
