Acute Kidney Injury

Question 1

Definition

Answer 1

Sudden decline in kidney function secondary to insult to the kidneys characterised by:
- Increase in creatine > 26mmol/l within 48 hours or 1.5 times increase about baseline in the last 7 days
- Decrease in urine output < 0.5ml/kg/hr for 6 consecutive hours

Question 2

Risk factors

Answer 2

Males
+65
CKD
HF
Diabetes
Smoking
Nephrotoxic drugs: ACE-I, NSAIDS, Diuretics
Iodine based contrast medium
Sepsis

Question 3

Diagnosis

Answer 3

RIFLE criteria, KDIGO criteria
U + E: confirm diagnosis = hyperkalaemia
FBC + CRP
VBG: metabolic acidosis
CXR: investigate pulmonary oedema
USS: Hydronephrosis, obstruction

Question 4

Nephrotoxic drugs

Answer 4

NSAIDS
ACE-Inhibitors
Angiotensin II inhibitors
Lithium
Cephalosporins

Careful with:
Metformin
Digoxin

Question 5

Safe drugs

Answer 5

Paracetamol
Warfarin
Statins
Aspirin 75mg
Clopidogrel
Beta blockers

Question 6

Types of renal replacement therapy

Answer 6

HEMODIALYSIS
Pros
- 4 dialysis free days
- Dialysis friends, act as support network
- No equipment needed at home
Cons
- Need to be in dialysis clinic = travel regularly require
- Lots of people dialysis same time, less privacy
- Restricted diet and fluid restrictions
- Side effects: headaches, nausea, leg cramps, tiredness and weakness
PERITONEAL
Pros
- Can be carried out at home
- Fewer restrictions on diet and fluid intake
Cons
- Needs to be done everyday
- Permanent catheter in abdomen
- Risk of developing peritonitis
Haemofiltration
PROS
- Adverse cardiovascular effects are reduced
- Can be combined with haemodialysis = haemodiafiltration = more effective than two treatments individually
CONS
- Expensive
Renal transplantation