Acute kidney injury Flashcards
The NICE criteria measure …. to assess for AKI
Serum creatinine
An increase by how much micromol/L of creatinine in 48 hrs signifies an AKI
> 25
An increase in what % of serum creatinine over 7 days signifies an AKI
50
A decrease of urine output by how much for 6 hours signifies an AKI
<0.5 ml/kg/hour
Nephrotoxic meds & substances that are RFs of AKI
- NSAIDs
- ACEi
- contrast medium use
Other AKI RFs (just to be aware of)
- CKD
- HF
- DM
- liver disease
- surgery
- > 65yo
- cognitive impairment
Most common cause of AKI
Pre-renal
Underlying pathology in pre-renal AKI
Inadequate renal perfusion
Pre-renal & renal AKI lead to
Reduced blood filtration
Causes of pre-renal AKI
- dehydration
- hypotension
- HF
Underlying pathology of renal AKI
Intrinsic kidney disease
Causes of renal AKI
- glomerulonephrtis
- interstitial nephritis
- acute tubular necrosis
Underlying pathology of post-renal kidney disease
Obstruction of outflow
Post-renal kidney disease leads to & how does that lead to reduced kidney function
Obstructive uropathy —> back-pressure
Causes of post-renal AKI
- kidney stones
- masses
- urethral strictures
- enlarged prostate
In a urinalysis, interpret the presence of: leukocytes + nitrates; protein + blood; glucose
- infection
- acute nephritis
- diabetes
USS can be used to exclude
Obstruction
Prevention of AKI
- hydration
- cease nephrotoxic meds
Philosophy of AKI Tx
Treat underlying cause
When to use IV fluid rehydration
Pre-renal
Restoring perfusion and filtration pressure is done thru
Ceasing nephrotoxic medications
Post-renal AKI is resolved by
Removing obstruction
Severe/doubtful cases solutions (2)
- specialist
- dialysis
AKI complications (list to be aware of)
- hyperK —> peripheral neuropathy
- fluid overload —> HF, p oedema
- metabolic acidosis —> ++H+
- encephalopathy/pericarditis —> uraemia
Is paracetamol safe to continue in AKI
Yes
Is warfarin safe to continue in AKI
Yes
Is statins safe to continue in AKI
Yes
Is aspirin safe to continue in AKI
Yes (cardioprotective dose)
Is clopidogrel safe to continue in AKI
Yes
Is beta-blockers safe to continue in AKI
Yes
Is NSAIDs safe to continue in AKI
No
Is aminoglycosides safe to continue in AKI
No
Is ACEi safe to continue in AKI
No
Is angiotensin II receptor antagonist safe to continue in AKI
No
Is diuretics safe to continue in AKI
No
Nephrotoxic drugs that can still be used in AKI since they dont worsen AKI
- metformin
- lithium
- digoxin
Explain AKI complication peripheral neuropathy
HyperK
Explain AKI complication HF & P oedema
Fluid overload
Explain AKI complication acidosis
++ H+
Explain AKI complication encephalopathy/pericarditis
Uraemia
