Acute Kidney Injury Flashcards
What is the definition of acute kidney damage?
Increase in SCr by >0.3mg/dl within 48 hours
Increase in Str to >1.5 times baseline
Urine volume <0.5 ml/kg/h for 6 hours
What are the pre renal causes of acute kidney damage?
Reduced effective circulating volume (Hypotension, shock, congestive cardiac failure, liver failure)
Arterial occlusion
Vasomotor (ACEI, NSAIDs)
What are the renal causes of acute kidney damage?
Acute tubular necrosis
Acute interstitial nephritis
Acute glomerulonephritis
Intrarenal vascular obstruction
What are the post renal causes of acute kidney damage?
Obstruction (stone, clot, malignancy)
What are the risk factors for radio contrast nephropathy?
Diabetes Renovascualar disease Impaired renal function Paraprotein High volume of radiocontrast
What are the toxin related causes of AKI?
Radiocontrast Snake venom Haem pigments Mushrooms Heavy metals (Pb, Hg) Drugs (ahminoglycosides, NSAID)
What are the causes of AKI?
Cardiac failure Haemorrhage Sepsis Vomiting and diarrhoea Tumours Prostate disease Stones Drugs Myeloma Radiocontrast Glomerulonephritis
What is myeloma?
A monoclonal proliferation of plasma cells producing an excess of immunoglobins and light chains
What are the clinical features of myeloma?
Anaemia Back pain Weight loss Fractures Infections Cord compression Hypercalcaemia
How is myeloma diagnosed?
Bone marrow aspirate
Serum paraprotein
Urinary Bence Jones protein
Skeletal survey
What are the investigations used for AKI?
History and examination Urine dipstick FBC USS Blood gas U and Es Renal function etc
What are the possible consequences of AKI?
Acidosis
Electrolyte imbalance
Intoxication toxins
What is the management of AKI?
Fluid balance
Optimise blood pressure
Stop nephrotoxic drugs
What is the treatment for intoxication?
Use antidote if available
May require RRT
What is the treatment for hyperkalaemia?
Calcium gluconate Salbutamol Insulin-dextrose Dialysis Anion exchange resins
What are the indications for dialysis in AKI?
Intoxication (aspirin, lithium, metformin, methanol, theophylline)
Overload (pulmonary oedema, hypertension)
Uraemia (altered mental state, pericarditis, unexplained bleeding)
Electrolytes (Increased K, Ca, Na, uric acid, PO4, Mg, decreased Na)
Acidosis (Increased lactate, pCO2, decreased HCO3)
What are the advantages of dialysis?
Rapid solute removal
Rapid volume removal
Rapid correction of electrolyte disturbances
What are the disadvantages of dialysis?
Haemodynamic instability
Fluid removal only during short treatment time
Concern if dialysis associated with hypotension
How can radio contrast nephropathy be prevented?
Saline hydration
NaHCO3
N-acetyl cysteine
