acute kidney injury Flashcards
what defines the different KDIDO staging
risk factors for AKI
-older age
-CKD
-diabetes
-cardiac failure
-liver disease
-PVD
-previous AKI
-hypotension
-hypovoleamia
-sepsis
-deteriorating NEWS
-recent contrast
0exposure to certain medications
causes of pre-renal AKI
- hypovolaemia (haemorrhage, volume depletion)
- hypotension (cardiogenic shock, distributive shock)
- renal hypoperfusion (NSAIDs, ACEis)
what is pre renal AKI
reversible volume depletion leading to oliguria and increase in creatinine
what does untreated pre-renal AKI lead to
acute tubular necrosis
what is acute tubular necrosis
- due to a combination of factors leading to decreased renal perfusion
- common causes are sepsis and severe dehydration
treatment for pre renal AKI
assess for hydration (JVP, cap refill, BP, HR etc) fluid challenge for hypovolaemia -crystalloid or colloid -give bolus of fluid then reassess and repeat
do you give 5% dextrose for pre renal AKI
no
what is renal AKI
diseases causing damage or inflammation to cells causing AKI
vascular causes of renal AKI
- vasculitis
- renovascular disease
glomerular causes of renal AKI
glomerulonephritis
causes of interstitial nephritis (that then causes renal AKI)
- drugs
- infection
- systemic (sarcoid)
causes of tubular injury (that then causes renal AKI)
- ischaemia
- drugs
- contrast
- rhabdomyolysis
symptoms of AKI
- constitutional weight loss
- fatigue
- nausea and vomiting
- fluid overload (oedema, SOB)
signs of AKI
- fluid overload including HTN, oedema, pul oedema, effusions
- uraemia
- itch
- pericarditis
- oliguria
investigations for AKI
- U&E’s
- FBC and coagulation screen
- urinalysis
- USS
- immunology
- protein electrophoresis
if someone has really small kidneys what does this suggest
chronic kidney disease
what would ANA point you towards
lupus
what would ANCA point you towards
vasculitis
what would GBN point you towards
- vasculitis
- good pastures
what do you do if an adequate BP is still not reached after fluid resuscitation
inotropes/vasopressors
life threatening complications of AKI
- hyperkalaemia
- fluid overload (pulmonary oedema)
- severe acidosis
- uraemic pericardial effusion
- severe uraemia
treatment of post renal AKI
- relieve obstruction (catheter, nephrostomy)
- refer to urology if ureteric stenting required
why is hyperkalaemia life threatening
associated with cardiac arrythmias
how much potassium is hyperkalaemia
> 5.5
assessment of hyperkalaemia
- ecg
- muscle weakness
what level is life threatening hyperkalaemia
> 6.5
what will normalise the ECG in hyperkalaemia
10mls of 10% calcium glucinate
treatment for hyperkalaemia
- cardiac monitor and IV access
- 10mls 10% calcium gluconate (2-3 mins)
- insulin with 50mls 50% dextrose (30mins)
- salbutamol nebs (90 mins)
- calcium resonium to prevent absorption from GI tract
urgent indications for haemodialysis
- hyperkalaemia
- severe acidosis
- fluid overload
- urea >40, pericardial rub/effusion
- B
- A
- C
- D
D
E
D
treatment for this case?
- restore renal perfusion by giving fluids
- stop all meds apart from ranitidine
- treat the hyperkalaemia (IV access, cardiac monitoring etc)
which drugs would you avoid in a patient with AKI
- NSAIDs
- ACE/ARB
- diuretics
- gentamicin
- contrast
- trimethorpim
- potassium sparing diuretics
