Acute Kidney Injury

Question 1

What is acute kidney injury?

Answer 1

Acute fall in GFR

Creatinine increase from baseline by 25 umol/L or 150%

Urine output 6 hours

Question 2

What are the risk factors for AKI?

Answer 2

(SHARD2)

Septic/toxic/volume insults

Hypercalcaemia

Age

Renal artery stenosis

Disease (diabetes, CCF, low eGFR) Drugs (ARBs, ACEIs, NSAIDs, aminoglycosides, penicillins, contrast, anaesthetics)

Question 3

What are the important investigations in AKI?

Answer 3

Volume status

Urine studies (anuria - better prognosis)

Renal ultrasound

Question 4

What are the management principles of AKI?

Answer 4

• Determine cause
  
  • Chronic vs. acute (check creatinine, Hx)
  • Obstruction (anuria, hydronephrosis)
  • Volume status (pre-renal effect)
  • Intrinsic renal disease (urinalysis, Hx)
  • Major vascular occlusion (loin pain, haematuria))
• Monitor fluid status, creatinine, minimise ECV insults
• Treat acute metabolic complications (volume overload, hyperkalaemia, acidosis)
• Consider dialysis