Acute Kidney Injury

Question 1

What is the definition of acute kidney injury?

Answer 1

Increase in SCreatinine:

• By 26.5umol/L or more within 48 hours or
• To 1.5x baseline, which is known or presumed to have occurred within the 7 prior days or
• Urine volume <0.5ml/kg/h for 6 hours

Question 2

What many stages of acute kidney injury are there?

Answer 2

3

Question 3

What is the serum creatinine and urine output for AKI stage 1?

Answer 3

Question 4

What is the serum creatinine and urine output for AKI stage 2?

Answer 4

Question 5

What is the serum creatinine and urine output for AKI stage 3?

Answer 5

Question 6

What does the immediately dangerous consequences of AKI depend on?

Answer 6

The immediately dangerous consequences of AKI depend on cause to an extent at least in the first few hours:

• Acidosis
• Electrolyte imbalance
• Intoxication toxins
• Overload
• Uraemic complications

Question 7

What can the causes of AKI be classified into?

Answer 7

Pre-renal

Intrinsic (renal)

Post-renal

Question 8

What are possible bad short term and intermediate/long term complications of AKI?

Answer 8

• Short term (in hospital)
  
  • Death, dialysis, length of stay
• Intermediate/long term (post-discharge)
  
  • Death, CKD, dialysis, CKD related CV elements

Question 9

What are pre-renal causes of AKI?

Answer 9

• Cardiac failure
• Haemorrhage
• Sepsis
• Vomiting and diarrhoea

Question 10

What are intrinsic renal causes of AKI?

Answer 10

• Glomerulonephritis
• Vasculitis
• Radiocontrast
• Myeloma
• Rhadomyolysis
• Drugs
  
  • NSAIDs, gentamicin

Question 11

What are post renal causes of AKI?

Answer 11

• Tumours
• Prostate disease
• Stones

Question 12

What are some causes of AKI?

Answer 12

Pre-renal:

• Cardiac failure
• Haemorrhage
• Sepsis
• Vomiting and diarrhoea

Intrinsic:

• Glomerulonephritis
• Vasculitis
• Radiocontrast
• Myeloma
• Rhadomyolysis
• Drugs
  
  • NSAIDs, gentamicin

Post-renal

• Tumours
• Prostate disease
• Stones

Question 13

How is AKI prevented?

Answer 13

STOP

Sepsis

Toxins

Optimise BP

Prevent harm (U & Es daily, urine outflow)

Question 14

What are some risk factors for AKI?

Answer 14

Age > 75

Previous AKI

Heart failure

Liver disease

Chronic kidney disease

DM

Vascular disease

Cognitive impairment

Question 15

Much of AKI is avoidable, how can it be prevented?

Answer 15

• Avoid dehydration
• Avoid nephrotoxic drugs
• Review clinical status in those at risk and act on findings

Question 16

What investigations should be done for AKI?

Answer 16

• Renal function
• Urine dipstick
• FBC
• USS
• Blood gas
• Specific blood tests if indicated

Question 17

What parts of the history are important for AKI?

Answer 17

Question 18

What are potential indications for renal replacement therapy (RRT)?

Answer 18

• Dependant on cause to an extend of at least in the first few hours
  
  • Acidosis
  • Electrolyte imbalance
  • Intoxication toxins
  • Overload
  • Uraemic complications

Question 19

What electrolyte imbalance can occur in AKI that can have serious consequences?

Answer 19

Hyperkalaemia

Question 20

What is the treatment of hyperkalaemia?

Answer 20

• Stabilise (myocardium)
  
  • Calcium gluconate
• Shift (K⁺ intracellularly)
  
  • Salbutamol
  • Insulin-dextrose
• Remove
  
  • Diuresis
  • Dialysis
  • Anion exchange resins