Acute Kidney Injury Flashcards
How is an acute kidney injury mathematically defined?
An increase in serum creatinine that by:
At least 26.5umol/L within 48 hours
OR
At least 1.5 times the baseline, which is know it presumed to have occurred in the last 7 days
OR
Urine volume less than 0.5ml/kg/h for 6 hours
What are the immediately dangerous consequences of AKI?
Acidosis Electrolyte imbalance Intoxication- toxins Overload Uraemic complications
What are the short term outcomes of AKI?
Death
Dialysis
Long hospital stays
What are the long term outcomes of AKI?
Death
Chronic kidney disease (and associated cardiovascular events)
Dialysis
What are the pre-renal causes of AKI?
Circulation volume depletion Hypotension/shock Congestive cardiac failure Liver failure Arterial occlusion Vasomotor- NSAIDs, ACE inhibitors
What are the renal causes of AKI?
Acute tubular necrosis Toxin related Acute interstitial nephritis Acute glomerulonephritis Myeloma Intra renal vascular obstruction
What are the post renal causes of AKI?
Obstruction- intraluminal, intramural, extramural
What are the risk factors for radiocontrast nephropathy?
Diabetes mellitus Renovascular disease Impaired renal function Paraprotein High volume of radiocontrast
What are the causes of AKI?
Cardiac failure Haemorrhage Sepsis Vomiting and diarrhoea Tumours Prostate disease Stones Drugs Rhabdomyolysis Myeloma Radiocontrast Vasculitis Glomerulonephritis
What investigations can be helpful in AKI?
History Examination Renal function Urine dipstick FBC USS Blood gases Histology Radiology
What steps can be taken to prevent AKI?
Sepsis- screen and treat promptly
Toxins- avoid if at risk of AKI
Optimise- BP and volume stats
Prevent harm- daily U&Es, fluid balance and medication review
What criteria should be thought about when managing AKIs?
Do they need fluid Can you remove the precipitant Can you stop it getting worse Do they need a catheter How to make them safe
How is fluid balance managed in AKI?
Give fluid if volume depleted
Restrict fluid if volume overload
How is blood pressure managed in AKI?
Give fluid or vasopressors
Stop ACE inhibitors and anti-hypertensives
What kind of drugs should be stopped in AKI?
Nephrotoxic drugs such as NSAIDs or aminoglycosides
