Acute Kidney Injury Flashcards
1
Q
Definition of AKI
A
Abrupt (<48 hrs) reduction in kidney function
Absolute increase in serum creatinine by >26.4 umol/L
2
Q
Staging system for AKI
A
KDIGO
3
Q
3 broad causes
A
Pre-renal
Renal
Post-Renal
4
Q
Pre-renal causes
A
- Hypovolaemia (haemorrhage, burns
- Hypotension (Shock, Sepsis, anaphylaxis)
- Renal Hypoperfusion (NSAIDS, ACEis, renal artery stenosis)
5
Q
Pre-renal management
A
- Correct volume depletion! Abs for sepsis. Inotropic support for shock.
6
Q
Failure to treat Pre-renal may cause …
A
Acute Tubular Necrosis (most common form of AKI)
7
Q
40-70% cases of AKI are…
A
Pre-renal
8
Q
Renal causes:
A
- Vascular
Vasculitis, malignant hypertension, large vessel occlusion, eg dissection or thrombus - Glomerular
Glomerulonephritis - Tubulointerstitial
Ischaemia (prolonged renal hypoperfusion > Acute tubular necrosis. Drugs (e.g. Gentamicin), Contrast, Rhabdomyolysis.
9
Q
Management for renal causes:
A
Refer to nephrology
10
Q
10-50% of AKI causes are…
A
Renal
11
Q
Post Renal causes:
A
- Stones, Cancers, Strictures, Extrinsic Pressure
- Obstruction > hydronephrosis
12
Q
10-25% of AKI caused by
A
Post renal causes
13
Q
Management of post renal causes:
A
CT of tract and consider cystoscopy or retrograde stent
14
Q
Complications of AKI:
A
- Hyperkalaemia - calcium gluconate > Insulin/glucose
- Pulmonary Oedema - O2 + IV furosemide
- Uraemia - may require dialysis if severe
- Acidaemia - consider sodium bicarbonate IV
15
Q
ROUNDUP26
A
R = record baseline creatinine + regular U+Es O = Obstruction excluded (clinical/USS) U = Urinalysis +/- MSU N = Nephrotoxic Drugs stopped (ACEi, NSAIDs, Contrast, Gentamicin) D = Dry (IV fluids 0.9% saline) or Wet (Furosemide) U = monitor Urinary output P = Prescription review 26 = creatinine rise required for diagnosis of AKI
