Acute kidney injury (AKI)

Question 1

What is the current definition of AKI

Answer 1

Increase in serum creatinine by at least 26.5 micromol/litre within 48 hours
or to increase their baseline by 1.5 times within the 7 days prior

Question 2

Describe AKI stage 1

Answer 2

1.5-1.9x the baseline
more than or equal to 26.5 micromol/Litre increase in serum creatinine
Urine output<0.5 ml/kg/hour for 6 hours

Question 3

Describe AKI stage 2

Answer 3

2-2.9x the baseline
urine output<0.5 for at least 12 hours

Question 4

Describe AKI stage 3

Answer 4

3x the base line
Serum creatinine increase to at least 354micromol/l
Or initiation of RRT - renal replacement therapy
urine output <0.3mg/kg/hour for more than 24 hours or anuria for more than 12 hours

Question 5

What are the immediate dangerous consequences of AKI

Answer 5

AEIOU
A - acidosis
E - electrolyte imbalance
I - intoxication (toxins)
O - overload
U - uraemic complications

Question 6

What are the types of causes of renal failure

Answer 6

Pre-renal - most common

Intrinsic

Post-renal

Question 7

What are pre-renal causes of AKI

Answer 7

Anything that alters the blood supply to the kidney e.g hypovolaemia, hypertension, sepsis…

Question 8

What are post renal causes of AKI

Answer 8

After the kidney so normally affecting the outflow of urine therefore: tumours, prostate disease and calculi (stones)

Question 9

What are intrinsic causes of AKI

Answer 9

Within the kidney like glomerulonephritis and vasculitis

Question 10

What are steps taken to prevent AKI

Answer 10

S - sepsis - test for sepsis because it increases risk of AKI
T - toxins
O - optimise BP
P - prevent harm - maintain fluids and medication

Question 11

What is done to review AKI

Answer 11

BUMP
B - Bloods
U - ultrasound
M - medication
P - plan for fluid maintainence

Question 12

When is RRT indicated

Answer 12

If no treatment is working for the AKI and stopping the initial cause of the AKI is not helping either

Question 13

What are changes to an ECG when there is hyperkalaemia

Answer 13

Peaked T waves
P waves begin to lengthen and flatten out and the PR segment becomes longer
Eventually the P waves disappear
Can cause:
cardiac arrest
asystole
ventricular fibrillation
Any kind of conduction block
bradycardia

Question 14

What is the treatment for hyperkalaemia - to stabilise the myocardium

Answer 14

calcium gluconate

Question 15

What is the treatment for hyperkalaemia - to shift the potassium back into the cell

Answer 15

Salbutamol neubulisers, insulin and dextrose - push potassium back into the cell

Question 16

What is the treatment for hyperkalaemia - to remove the potassium

Answer 16

Diuresis
Dialysis
Binders - lokelma