Acute Kidney Injury Flashcards
What is AKI?
Acute reduction in kidney function, raised creatinine
Classification of AKI, and what’s the most common cause and why?
Pre-renal - most common due to hypoxia, leading to acute tubular necrosis
Renal
Post renal
Why might someone with pneumonia get AKI?
Vasodilation from sepsis - hypoxia to kidneys - ATN - creatinine has increased
Pneumonia scoring - why do we use this score?
CURB 65 - basically you’re seeing if there’s an AKI or sepsis
Confusion
Urea over 7mmol/L
Resp rate over 30
BP low - systolic less than 90 or diastolic less than 60
>65
How would you manage this patient?
Give oxygen
Give fluids (but do fluid status exam first)
CURB 65 score 0-1 mx
Amoxicillin, 5 days outpatients
CURB 65 score 2 mx
Amox + clari - consider admission
CURB 65 score 3-5 mx
Co-amox + clari + admit
What is involved in a fluid status examination
JVP
Skin turgor
Check for oedema - sacral, pedal
How would you manage someone with an AKI from a GI bleed?
Terlipressin
Fluid resuscitation:
Hartmans
Jellafusin
or transfusion
If there’s hydronephrosis but a urethral stricture, what do you do?
Nephrostomy - goes into pelvic catheter
How do you treat an AKI?
Take a hx
Treat underlying intercurrent condition to restore renal blood flow
If not passing urine - do renal USS
If obstruction - bladder catheter/nephrostomy
Remove nephrotoxic drugs or anything that is reducing blood flow like ACEi.
If not, call the nephrologists to investigate further for intrinsic kidney injury
Intrinsic kidney injury - what symptoms can present?
Nephritic syndrome
Uremia
Blood in urine
Raised blood pressure
Nephrotic syndrome
Oedema
Proteinuria
Hypoalbuminemia
Why might someone who has fallen get an AKI?
Rhabdomyolylsis - ATN due to myoglobin
How do you stage AKI
Creatinine = how much it is above baseline
3x above baseline = stage 3
2-2.9x above baseline = stage 2
1.5-1.9x above baseline = stage 1
