Acute Kidney Injury Flashcards
Acute kidney injury is defined as being an increase in serum creatinine by how much AND urine volume of how much?
Increase in serum creatinine: by ≥ 26.5 μmol/l (0.3 mg/dl ) within 48 hours
or
to ≥ 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days
AND
Urine volume <0.5ml/kg for 6hrs
What are some of the immediately dangerous consequences of AKI?
Acidosis
Electrolyte imbalance
Intoxication
Overload
Uraemic complications
AEIOU
For AKI Stage 1, what is the serum creatinine level?
1.5-1.9 x the baseline
For AKI Stage 1, what is the urine output?
<0.5ml/kg/h for 6-12hrs
For AKI Stage 2, what is the serum creatinine level?
2-2.0 x the baseline
For AKI Stage 2, what is the urine output?
<0.5ml/lg/h for >12hrs
For AKI Stage 3, what is the serum creatinine level?
3 x the baseline
What are some of the pre-renal causes of AKI?
Cardiac failure
Haemorrhage
Sepsis
Vomiting and diarrhoea
What are some of the intrinsic causes of AKI?
Glomerulonephritis
Vasculitis
Radiocontrast
Myeloma
Rhabdomyolysis
Drugs e.g. NSAIDs, gentamicin
What are some post-renal (obstruction) cause of AKI?
Tumours
Prostate disease
Stones
What are some risk factors for AKI?
Age >75
Previous AKI
Heart failure
Liver disease
CKD
Diabetes
Vascular disease
Cognitive impairment
What are some risk events for AKI?
Sepsis
Toxins
Hypotension
Hypovolaemia
Major surgery
List some toxins which should be avoided if a patient is at risk of AKI.
Gentamicin
NSAIDs
IV iodinated contrast
There are some medications which should not be taken if someone has vomiting or diarrhoea, fevers, sweats and shaking.
They can be restarted when the individual is well.
Give some examples of these medicines.
ACEi
ARBs
NSAIDs
Diuretics
Metformin
Give some examples of ACEi
Ramipril, lisinopril
Give some examples of ARBs
Candesartan, valsartan
Give some examples of NSAIDs
Ibuprofen, naproxen
Give some examples of diuretics
Furosemide
Spironolcatone
RECAP- what is metformin used in the treatment of?
Diabetes
Assessing volume status in a patient with AKI is essential.
If a patient is hypovolaemic, what should be done?
Give boluses of fluid as per IV perscription guidelines
Then treat as per euvolaemia*
*normal amount of fluids in the body
Assessing volume status in a patient with AKI is essential.
If a patient is euvolemic, what should be done?
Give only maintenance fluid
The response to AKI can be remembered using the acronym SHOUT.
Run through this please!
Suspect sepsis
Hypovolaemia
Obstruction- consider bladder scan and/or ultrasound
Urinalysis
Toxins
What kind of investigations are carried out in someone with suspected AKI?
Renal function test
Urine dipstick
FBC
USS
Blood gas
More specific blood tests if required
What blood tests would routinely get done for someone with suspected AKI?
U&Es
Bicarb
LFT’s
FBC
Clotting
What we be looked at in urinalysis using a urine dipstick for someone with suspected AKI?
Blood?
Protein?
Using the acronym BUMP, what gets covered/considered in an AKI review?
Bloods
Ultrasound?
Medicines - to ensure appropriate dose adjustments
Plan for fluid maintenance
What should be done in an AKI follow-up?
Repeat bloods to ensure back to normal
Treatment and medicine review
What changes would be seen in an ECG if a patient had hyperkalaemia?
Peaked T waves
P wave widens and flattens
PR segment lengthens
P waves eventually disappear
Prolonged QRS interval
Arrhythmias
->Tall T waves are usually one of the earliest signs of hyperkalaemia
Describe the treatment for hyperkalaemia.
->apparently one of the most important slides for our future careers uh oh
Firstly, stabilise the heart and myocardium by giving calcium gluconate.
This is essential but doesn’t do anything to potassium levels so potassium needs to be shifted intracellularly. This can be done by using a salbutamol nebuliser or giving an insulin-dextrose infusion.
Then remove the excess potassium using diuresis, dialysis or potassium binders
->wordy but please just try and read through and get the basics
