Acute kidney injury Flashcards
What is AKI?
AKI is a syndrome of decreased renal function over hours-days, recognised by the rise in serum creatinine and decreased urine output.
What are the stages of AKI?
1,2,3, based on increasing serum cr and decreasing urine output
What are the subtypes of AKI?
Pre-renal: sepsis and dehydration, drugs (NSAID, ACEi), shock, fluid loss
Renal: damage to the cells of kidney e.g. ATN, GN, vasculitis, immune reactions e.g. HUS, TTP
Post-renal: stones, malignancy, BPH
What are risk factors for AKI?
• CKD
• ACEi use
• Hypotension
Hypercholesterolaemia
What are the most important things to recognise and treat in patients with AKI?
Pulmonary oedema
Hyperkalaemia
What initial assessments should you do in patients with AKI?
Find out cause
Fluid status: BP, pulse, JVP, third heart sound, skin turgor… give a fluid challenge if dry and diuretics if wet.
Review meds: stop nephrotoxins and any drugs which increase complications e.g. K sparing diuretics, ACEi
Exclude obstruction
What investigations should you do in patients with AKI?
Urinalysis: blood/protein may suggest GN
U+Es, FBC, VBG: hyperkalaemia and acid base balance, lactate and CK
Consider US if cause unclear
What are the relative and absolute indications for RRT?
Absolute: refractory K >6.5
refractory pulmonary oedema
Relative: acidosis (PH <7.1), uraemia (>40) (pericarditis and encephalopathy), toxins e.g. lithium
What is acute interstitial nephritis?
Inflammation in kidney interstitium, causing AKI
What drugs can cause interstitial nephritis?
Abx e.g. penicillin and rifampicin, NSAIDs, allopurinol, furosemide, systemic disease, infection
What are Sx and Ix of interstitial nephritis
fever, rash, arthralgia
hypertension
eosinophilia
Sterile pyuria with white cell casts
What are complications of AKI?
Death
Arrhythmia
Pulmonary oedema
What is rhabdomyolysis
Breakdown of muscle causing elevated CK, AKI
Why does rhabdomyolysis happen
Usually in patients with falls or prolonged epileptic seizures, also ecstasy, crush injuries, statins
What drugs should be stopped if patient has an AKI?
K sparing diuretics
NSAIDs
ARB/ACEi
Gentamicin
