Acute Kidney Injury Flashcards
what is AKI
abrupt reduction in kidney function as an increase in serum creatinine by > 26.4micromol/l or increase of baseline by 50% or reduction in urine output
what are pre renal causes of AKI
hypovolaemia- biggest cause, hypotension, drugs- NSAIDS, COX2 inhibitors, ACEi,
what is oliguria
less urine passed 0.5ml/kg/ hour
what happens to GFR when started on an ACEi
creatinine goes down
what do you need to do if start vomiting and diarrhoea when on ACEi and NSAIDS?
stop medication through illness
what does pre renal AKI lead to?
Acute tubular necrosis
what is the commonest cause of AKI in hospital
Acute tubular necorsis
what are the commonest causes of AKI
dehydration and sepsis
how do you treat AKI
assess hydration status- JVP, pulmonary oedema, oedema,
hypovolaemia treatment
Do not give 5% dextrose- won’t go into intravascular volume
what are renal causes of AKI
vasculitis- ANCA, glomerular diseases- glomerulonephritis, good pastures, infective endocarditis, acute tubular necrosis, drugs- antibiotics, PPi and NSAIDS, tubular injury- rhabdomyolysis, contrast, drugs
what are signs and symptoms of AKI
nausea and vomiting, WL, anorexia, fluid overload, pulmonary oedema, pericardial rub, pericarditis
what are clues to renal cause
sore throat- pos strep? D and V- ACEi Cough up blood- Goodpastures urinalysis- protein and blood recent contrast? Can precipitate AKI
what can compartment syndrome lead to
rhabdomyalysis
what are investigations in AKI
U and Es FBC and coag screen- sepsis Urinalysis USS- obstruction? GBM- good pastures, ANA-SLE, ANCA- vasculitis Myeloma screen for > 50s
when would you do a renal biopsy
when vasculitis is suspected
what should you makes sure the patient is not on in before renal biopsy
aspirin, warfarin,
what are life threatening complications of AKI
hyperkalaemia, fluid overload, severe acidosis, uraemic pericardial effusion, severe uraemia
what a repost renal causes of AKI
stones, cancers, strictures, extrinsic pressure
what is seen on imaging in post renal obstruciton
dilated renal pelvis
what cardiac problem is hyperkalaemia associated with
cardiac arrhythmias
what is the hyperkalaemic values for non life threatening and life threatening hyperkalaemia
> 5.5 and >6.5
what ECG sign is seen in hyperkalaemai
‘tented T waves’
how do you treat acute hyperkalaemia
cardiac monitor and IV access
10mls 10% calcium glutinate
Insulin and dextrose
salbutamol nebuliser
what are the indications for Haemodialysis
hyperkalaemia >7 or unresponsive to medical therapy
Sever acidosis ph 40- pericardial rub/ effusion
