Acute Kidney Injury (AKI) Flashcards
Define Acute Kidney Injury (AKI)?
An abrupt loss of kidney function resulting in the retention of urea and other nitrogenous waste products and dysregulation of extracellular volume and electrolytes
What is the KDIGO classification of AKI?
Increase in serum creatinine > 26 µmol/L within 48 hrs
Increase in serum creatinine to > 1.5 times baseline within the preceding 7 days
Urine volume < 0.5 ml/kg/hr for 6 hours
What is the Aetiology of AKI?
Pre-Renal (90%)
Intrinsic Renal
Post-Renal (due to obstruction)
What are the Pre-Renal causes of AKI?
Hypovolaemia (e.g haemorrhage, severe vomiting)
Heart Failure
Cirrhosis
Nephrotic Syndrome
Hypotension (e.g shock, sepsis, anaphylasis)
Renal Hypoperfusion (e.g NSAIDs, ACE inhibitors, ARBs, renal artery stenosis)
What are the intrinsic renal risk factors of the AKI?
Glomerular - Glomerulonephritis, haemolytic uraemic syndrome
Tubular- acute tubular necrosis
Interstitial- acute interstitial nephritis (e.g. NSAIDs, Autoimmune)
Vasculitides (e.h. Wegener’s granulomatosis)
Eclampsia
What are the Post-Renal causes by AKI?
Calculi
Urethral Stricture
Prostatic Hypertrophy or malignancy
Bladder Tumour
What are the risk factors of AKI?
Age
Chronic Kidney Disease
Comorbidities (e.g. heart failure)
Sepsis
Hypovolaemia
Use of Nephrotoxic Medications
Emergency Surgery
Diabetes Mellitus
What is the epidemiology of AKI?
15% of adults admitted to hospital will develop an AKI
Most common in the elderly
What are the presenting symptoms of AKI?
Depends on Underlying CAUSE
Oliguria/anuria (abrupt anuria suggests post-renal obstruction)
Nausea/Vomiting
Dehydration
Confusion
What are the signs of AKI on physical examination?
Hypertension
Distended Bladder
Dehydration - postural hypotension
Fluid overload (in heart failure, cirrhosis, nephrotic syndrome) - raised JVP, pulmonary and peripheral oedema
Pallor, rash, brusing (vascular disease)
What are the appropriate investigations for AKI?
Urinalysis
Bloods
Ultrasound
Other Imaging:
CXR - pulmonary oedema
AXR - renal stones
What is the Urinalysis you can do for AKI?
Blood - suggests nephritic cause
Leucocyte Esterase and nitrites - UTI
Glucose
Protein
Urine Osmolality
What are the Bloods you can do for AKI?
FBC
Blood FIlm
U&Es
Clotting
CRP
What are the Immunology Bloods you can do for AKI?
- Serum Immunoglobulins and protein electrophoresis for multiple myeloma
- Also check for Bence-Jonce proteins in the urine
- ANA- associated with SLE
- Also check anti-dsDNA antibodies (high in active lupus)
- Complement Levels - low in active lupus
- Anti-GBM antibodies - Goodpasture’s syndrome
- Antistreptolysin-O antibodies -high after Streptococcal infection
What are the Virology tests you can do for AKI?
Check for Hepatitis
Check for HIV