increase > 1.5-1.9 x creatinine reference 6 hours

increase >2-2.9 x reference creatinine 12 hours

increase >3 x reference creatinine or increase to >354 or need for RRT 24 hours or no urine output for 12 hours

Acute Kidney Injury Flashcards by Beth Mickel

what is an acute kidney injury

an abrupt (<48 hrs) reduction in kidney function:

absolute increase in serum creatinine levels by >26
increase in creatinine by >50%
reduction in UO

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what is stage 1 AKI

increase > 1.5-1.9 x creatinine reference

<0.5ml/kg/hr urine output for >6 hours

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what is stage 2 AKI

increase >2-2.9 x reference creatinine

<0.5ml/kg/hr urine output for >12 hours

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what is stage 3 AKI

increase >3 x reference creatinine

or increase to >354

or need for RRT

<0.3ml/kg/hr urine output for >24 hours or no urine output for 12 hours

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what are some risk factors for AKI

older age 
chronic kidney disease 
diabetes 
cardiac failure 
liver disease 
peripheral vascular disease
previous AKI

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what are the 3 categories of AKI causes

Pre-renal (eg. change on blood volume to kidneys) 
Renal (structural) 
Post renal (obstruction)

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what is the most common cause of AKI

Pre-renal

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what are some pre-renal causes of AKI

Hypovolaemia

haemorrhage
volume depletion (burns)

Hypotension

cardiogenic shock (heart failure)
distributive shock (sepsis)

Renal hypoperfusion

NSAIDS
ACEi/ARBs
hepatorenal syndrome

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what does an untreated prerenal AKI lead to

Acute tubular necrosis

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What is a pre-renal AKI

reversible volume depletion leading to oliguria and increased serum creatinine

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what are the most common conditions to cause pre-renal AKI

sepsis
severe dehydration
rhabdomyolysis
drug toxicity

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treatment for pre-renal AKI

asses hydration

NEWS
JVP, capillary refit time, oedema

Fluid challenge for hypovolaemia

-normal saline (0.9% NaCl) bolus then reassessment and repeat if necessary

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what is a renal AKI

disease causing inflammation or damage to cells causing an AKI

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what are the main types of disease that cause renal AKI

Blood vessel disease
Glomerular disease
Interstitial injury
Tubular injury

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what diseases affect the renal blood vessels causing AKI

vasculitis 
renovascular disease (atherosclerosis in vessels in kidneys)

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what glomerular diseases cause renal AKI

glomerulonephritis

what interstitial injuries cause renal AKI

Drugs - penicillin, NSAIS, PPIs
Infection - TB
Systemic disease (sarcoidosis)

what tubular injuries cause renal AKI

ischaemia (prolonged renal hyper perfusion)
drugs (gentamicin)
contrast
rhabdomyolisis

what are the sings/symptoms of renal AKI

anorexia 
weight loss 
fatigue 
lethargy 
nausea and vomiting 
itch, pericarditis (uraemic symptoms) 
fluid overload (oedema, SOB) 
oliguria

what clues in the history suggest a renal AKI

rash (lupus or vasculitis) 
sore throat
joint pain (lupus) 
haemoptysis 
drug history 
recent contrast scans 
blood results (suggestive of vasculitis)

what type of AKI is it if there is protein and blood in the urine

renal cause of AKI

how long after a contrast scan does contrast nephropathy occur

within 72 hours

what does eosinophilia suggest

eosinophilic granulomatosis with polyangitis

what should you be worried about if patient has come in after lying for a v long time

rhabdomyolysis

what investigations are done for renal AKI

``` Us&Es FBC and coagulation screen Urinalysis USS Immunology Protein electrophoresis ```

treatment for general AKI

establish good perfusion pressure (fluid resuscitate and then vasopressors if needed) treat underlying causes (antibiotics if sepsis) stop nephrotoxins dialysis if patient remains anuric and uraemia

what are some life threatening complications of AKI

hyperkalaemia fluid overload severe acidosis ureic pericardial effusion severe uraemia

what is a post renal AKI

AKI due to obstruction of urine flow leading to back pressure (hydronephrosis) and therefore loss of concentrating ability of the kidneys

what are some causes of post renal AKI

stone cancers strictures extrinsic pressure

what is the treatment for post renal AKI

relieve obstruction - catheter - nephrostomy refer to urology if ureteric stenting required

what is hyperkalaemia

life threatening condition of too much K in the blood associated with cardiac arrhythmia

what are the ranges for normal - life threatening hyperkalaemia

normal - 3.5-5 hyperkalaemia >5.5 life threatening hyperkalaemia >6.5

how do you treat hyperkalaemia

- Cardiac monitor and IV access - Protect myocardium (calcium gluconate) - Move K+ back into cells (insulin with 50ml dextrose, salbutamol nebs) - Prevent absorption from GI tract (calcium resonium)

what gives urgent indication for dialysis

hyperkalaemia >7 or >6.6 but unresponsive to medical therapy severe acidosis - pH 7.15< fluid overload real pericardial rub/effusion

what is the mortality rate for AKI alone

10-30%

what is the mortality rate for AKI with one other organ dysfunction

30-50%

what is the mortality rate for AKI with multi-organ failure

70-90%

what percentage of people recover from AKI but have progressive CKD

5-10%

Triggers for AKI

``` hypotension hypovolaemia sepsis deteriorating NEWS recent contrast scan exposure to certain drugs ```