Acute kidney injury

Question 1

Define AKI stage 1

Answer 1

1.5-1.9 times baseline serum creatinine or >26.5 umol/l increase
or <0.5 ml/kg/ for 6-12 hours

Question 2

Define AKI stage 2

Answer 2

2-2.9 times baseline sC,
or
<0.5ml/kg/ for 24hrs

Question 3

Define stage 3 AKI

Answer 3

3 or more times sC baseline
or
increase to 354umol/l 
<0.3ml/kg/ for 24 +hrs
or Anuria for 12 +hrs
or 
initiation of renal replacement therapy

Question 4

What are the immediately dangerous consequences of AKI?

Answer 4

Remember AEIOU
Acidosis- can cause cardiac arrest
Electrolyte imbalance- can cause cardiac arrest
Intoxication toxins- respiratory the cardiac arrest
Overload- pulmonary oedema and cardiac arrest
Uraemic complications

These complications are not that common as they don’t usually occur in stage 1 or 2 AKI, which is what most patients with AKI have.

AKI long term outcomes - increases risk of death, cariac events and chronic kidney disease.

Question 5

What are the outcomes of AKI?

Answer 5

Of those who haven’t recovered within 7 days
30% will take over 90 days to recover
30% will die

Question 6

What are the causes of AKI?

Answer 6

Pre-renal: cardiac faliure
haemorrhage, sepsis, vomiting and diarrhoea (pre-renal are most common causes)
Renal-vasculitis, radiocontrast, myeloma, glomerulonephritis, drugs (NSAIDs or gentamicin)
Post-renal: tumours, prostatic disease, stones

Question 7

What is the earliest sign of hyperkalaemia?

Answer 7

Tall peaked T-waves on ECG
The p-waves will also become wider and eventually disappear with rising K levels.
Give calcium gluconate and salbutamol