Acute Kidney Injury

Question 1

What are the NICE criteria for diagnosing AKI?

Answer 1

1. Rise in creatinine of >25 micromol/L in 48 hours
2. Rise in creatinine of >50% in 7 days
3. Urine output of <0.5 ml/kg/hour for more than 6 hours

Question 2

How can you classify the causes of AKI?

Answer 2

Pre-renal
Renal
Post-renal

Question 3

What are the pre-renal causes of AKI?

Answer 3

Inadequate blood supply to kidneys e.g.:

• Hypovolaemia: dehydration; sepsis
• Hypoperfusion: renal artery stenosis

Question 4

What are the renal causes of AKI?

Answer 4

Intrinsic disease in the kidney:

• Glomerulonephritis
• Interstitial nephritis
• Acute tubular necrosis (ATN)

Question 5

What are the post-renal causes of AKI?

Answer 5

Obstruction:

• Stone, e.g. renal/bladder stone
• Mass, e.g. bladder/prostate Ca, BPE
• Stricture, e.g. ureteric/urethral stricture

Question 6

Describe the management of AKI

Answer 6

• Treat the underlying cause, e.g. IV fluids if pre-renal AKI, relieve obstruction if post-renal AKI
• Stop/withold nephrotoxic drugs
• Treat complications, e.g. hyperkalaemia

Question 7

What are the potential complications of AKI?

Answer 7

• Hyperkalaemia
• Metabolic acidosis
• Fluid overload

Question 8

Give some examples of drugs which can impair renal function

Should these be stopped in a patient with AKI?

Answer 8

RENAL:
R - Radiocontrast dye
E - Eplerenone (and ALL other diuretics)
N - NSAID
A - ACE inhibitor
L - Losartan (and other ARBs)

YES!!