Acute Kidney Injury Flashcards
What is an AKI?
Rapid reduction in kidney function over hours to days
KDIGO criteria for diagnosing AKI
Rise in creatinine >26μmol/L in 48hrs
Rise in creatinine >1.5 x baseline (best figure in last 3/12)
Urine output <0.5mL/kg/h for >6 consecutive hours
Risk for developing AKI
>75 years CKD Cardiac failure PVD Chronic Liver disease Diabetes Drugs Sepsis Poor fluid intake/ increased losses History of urinary symptoms
Pre renal causes of AKI
Hypotension
Hypovolaemia
Sepsis
Renal artery stenosis
Intrinsic renal causes
Tubular- ATN
Glomerular- SLE, HSP, drugs, infection
Interstitial- drugs, tumour lysis syndrome
Vascualr- vasculitis, malignant high bp, thrombus
Post Renal causes
Obstruction:
Luminal- stones, clots, sloughed papillae
Mural- malignanc, BP strictures
Extrinsic compression- malignancy, retroperitoneal fibrosis
Signs of fluid overload
High BP Increase JVP Lung crepitations Peripheral oedema Gallop rhythm on cardiac auscultation
Sign of low fluid
Decreased urinary output Non-visible JVP poor tissue turgor Low BP High pulse
Complications of AKI
Hyperkalaemia
Pulmonary oedema
Uraemia
Acidaemia
KDIGO Stage 1 AKI
creatinine rise ≥26.5µmol/l in 48h OR 1.5-1.9 times from baseline Urine Output: <0.5ml/kg/h for 6-12h
How do you manage a pre-renal cause of an AKI?
Correct volume depletion
Increase renal perfusion Via circulatory support
Treat any underlying sepsis
Stop any nephrotoxic drugs
How do you manage an intrinsic AKI?
Refer for likely biopsy
Specialist treatment for intrinsic renal disease
How do you manage a post renal AKI?
Catheter
Nephrostomy
Urological Intervention
Management of hypervolumiea?
Oxygen resuscitation
Diuretics
Fluid restriction
Renal replacement therapy
