Acute Kidney Injury **** Flashcards
What is an AKI?
2 ways to define
Rapid rise in creatinine or development of oliguria/anuria
Causes
Cardiac surgery Bone marrow transplantation Toxicity (NSAID's, ahminoglycosides, aciclovir) Sepsis Dehydration/diarrhoea Glomerulonephritis Drug induced haemolysis Snake bite Haemolytic uraemia syndrome Myoglobinuria
What is used to stratify the severity of an AKI in paediatrics?
RIFLE criteria based on the magnitude of changes in eGFR or urine output:
Risk Injury Failure Loss of kidney function End-stage renal failure
Causes for acute tubular necrosis (ATN)
Crush injury Burns Dehydration Shock Sepsis Malaria
Plasma chemistry in AKI
Do they go up, down or stay the same?
Potassium Creatinine Urea Phosphate Calcium Sodium Chloride
High potassium High creatinine High urea High phosphate or the same Low calcium Low sodium Low chloride
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MSU - if urine dip is positive for RBC’s, what could that suggest?
Haemolytic problem
Myoglobinuria
Other tests for AKI:
Bedside
Bloods
USS - what could a dilated ureter indicate?
ECG
Serum and urine osmolality
Creatinine Acid-base state PCV Platelets Clotting studies (DIC)
USS - looking for dilated ureters which could indicate a stone
Treatment for AKI:
(Remove or reduce the cause ASAP)
Who should be involved?
What should be treated first?
What to do if U/P osmolality ratio is >5?
What to do if ratio is low?
Paediatric nephrology team early
Shock and dehydration as that is what will kill them
Nothing - the oliguria should respond well to the rehydration
Try diuretics - furosemide slowly
Treatment for AKI:
What to give if BP is high?
What is the 24 hr fluid requirement
Nitroprusside
Labetalol is good alternative
Avoid over hydration
Replace losses + insensible loss
Aim for weight loss
Signs on ECG:
Tall T waves and QRS slurring
What could be causing this and how could it be treated
Hyperkalciemia
IV/nebulised salbutamol
What is the final option if all else fails?
Haemofiltration to peritoneal dialysis
