Acute Kidney Injury

Question 1

Describe your treatment strategy to deal with AKI.

Answer 1

1. Correct hypovolaemia (Stop diuretics and consider fluids)
2. Minimmise renal hypoperfusion (most often from drug therapy
3. Treat other causes such as sepsis
4. Avoid the use of nephrotoxic agents
5. Consider drugs at are renally excreted and may need adjusetment.
6. Get dipstick to exclude renal causes (look for proteinuria and blood.

Question 2

Name some common nephrotoxic drugs.

Answer 2

1. Aminogycosides
2. Amphotericin
3. Immunosuppressants
4. Lithium
5. NSAIDs
6. Radiocontrast media

Question 3

Name some nephrotoxic pathological states

Answer 3

1. Hypoperfusion
2. Sepsis
3. Rhabdomyolysis
4. Hepatorenal syndrome

Question 4

What is the most sensitive indicator of hypovolaemia?

Answer 4

A postural rise in heart rate of greater than or equal to 30bpm.

Question 5

In what situations are ACEi beneficial?

Answer 5

• ACEi and ARBs are not directly nephrotoxic but can promote a pre-renal state.
• Give to all diabetic patients with micro/macroalbuminuria.
• Give to all non-diabetic pateints with HTN and albumin:ratio >30mg/mmcreatine ol.
• Give to all non-diabetic patients with CKD and PCR >50mg/mmol.
• Check U&Es after 7 days.
• If eGFR falls 25% or more at the 7 day check then stop and look for cause of drop (?Renal artery stenosis etc)

Question 6

When should ACEi NOT be used?

Answer 6

1. Bilateral renal artery stenosis
2. Renal artery stenosis in a single kidney
3. Vasculopaths

Question 7

Which Beta-Blockers are best to use in resistant HTN and kidney disease?

Answer 7

Ones that are not renally excreted like bisoprolol and metoprolol.