Acute Kidney Injury Flashcards
describe mortality in AKI
predicted by its duration
increased risk with increase in creatinine
severe AKI can have mortality up to 50-80% in context of multi-organ failure requiring renal replacement therapy
cost implications of AKI?
extra 4.7 days in hospital
higher costs than breast, lung and skin cancer combined
definition of AKI?
an abrupt (<48 hrs) reduction in kidney function defined as
- absolute increase in serum creatinine by >26.4
- or increase in creatinine by >50%
- reduction in urine output
stage 1 AKI?
increase in creatinine > 26
or
increase > 1.5-1.9 X reference creatinine
urine output <0.5 ml/kg/hr for >6 consecutive hours
stage 2 AKI?
increase >2-2.9 X reference serum creatinine
urine output <0.5ml/kg/hr for >12 hrs
stage 3 AKI?
increase >3 X reference serum creatinine or increase to >354 or need for renal replacement therapy urine output <0.3ml/kg/hr for >24 hrs or 12 hrs for anuria
risk factors for AKI?
old age CKD diabetes cardiac failure liver disease PVD previous AKI gentamicin hypotension/hypovolaemia sepsis deteriorating NEWS recent radiological contrast drugs
3 groups of AKI?
pre-renal (functional) renal (structural) post renal (obstruction)
3 causes of pre-renal AKI?
hypovolaemia (haemorrhage, volume depletion - D&V, burns etc)
hypotension (cardiogenic shock, distributive shock - sepsis, anaphylaxis etc)
renal hypoperfusion (NSAIDs, COX-2, ACE/ARBs, hepatorenal syndrome)
how does pre renal AKI affect urine output?
reversible volume depletion leading to oliguria and increase in creatinine
- oliguria = <0.5ml/kg/hr
risk of antihypertensives in AKI?
reduce blood pressure and therefore reduce renal perfusion
if combined with e.g vomiting and diarrhoea which reduced blood volume further, can cause major drop in renal perfusion leading to major fall in GFR
perfusion requirements of kidneys?
receive 20-25% of whole cardiac output
untreated pre-renal AKI can lead to what?
acute tubular necrosis
what is acute tubular necrosis?
commonest form of AKI in hospital
due to combination of factors leading to decreased renal perfusion
what can cause acute tubular necrosis?
sepsis
severe dehydration
rhabdomyolysis
drug toxicity
how is pre-renal AKI assessed for hydration?
clinical observation
JVP, cap refill, oedema
pulmonary oedema
how is fluid given in pre-renal AKI?
crystalloid (0.9% NaCl) or colloid (gelofusin)
DO NOT USE DEXTROSE
give bolus of fluid then reassess and repeat as necessary
if >1 L has been given with no improvement, seek help
categories of renal AKI?
divided by structure affected: blood vessels glomerular disease interstitial injury tubular injury
vascular causes of renal AKI?
vasculitis
renovascular disease
glomerular causes of AKI?
glomerulonephritis
interstitial causes of AKI (interstitial nephritis)?
drugs
- NSAIDs, PPIs, penicillin, gentamicin
infection (TB)
systemic (sarcoidosis)
what can cause tubular injury AKI?
ischaemia
drugs (gentamicin)
contrast
rhabdomylolysis
symptoms and signs of AKI?
constitutional (weight loss, fatigue, lethargy)
nausea and vomiting
itch
fluid overload (oedema, breathless, pulmonary oedema, hypertension, effusions)
uraemia (including itch, pericarditis etc)
oliguria
examples of history which can point to cause of AKI?
sore throat - strep rash - vasculitis joint pains - vasculitis D&V - haemoptysis - ANCA associated vasculitis, goodpastures
