Acute Kidney Injury Management****

Question 1

Fluid balance - Volume status:

What are the signs of hypovolaemia? - 6

What are the signs of hypervolaemia? -

Answer 1

Hypotension 
Low urine output
Non-visible JVP 
Poor tissue turgor
Tachycardia 
Daily weight loss 

Hypertension 
Raised JVP 
Lung crepitations - pul oedema
Peripheral oedema 
Gallop rhythm

Question 2

Hypovolaemia, fluid resuscitation:

What is crystalloid?

What is colloid?

Answer 2

Fluids

Bloods

Colloid has 2 o’s so it is blood!!!

Question 3

Hypovolaemia, fluid resuscitation:

What electrolyte does saline contain that risks reaching high level? What would the effect of this be?

What electrolyte does Hartmann’s contain that risks reaching high levels?

What will inotropes do?

Answer 3

Saline contains chloride ions - hyperchloremic metabolic acidosis

Hartmann’s contains potassium ions - hyperkalaemia

Helps CV supply

Question 4

Hypervolaemia, fluid overload:

What may be needed if there is pul oedema if they become SOB?

What can be done to prevent it from getting worse?

What drug can be given?

What is done if this occurs with oligo/anuria? - THINK CAREFULLY

Answer 4

Oxygen

Fluid restriction

Diuretics

Renal replacement therapy (RRT) - this is critical an urgent - this is because the kidneys are not even producing urine and getting rid off water - usually you would produce urine to balance fluids.

Question 5

Hyperkalaemia:

4 ECG changes - think from start to finish

Over what levels are ECG changes found?

What should be used to investigate this immediately if it is suspected?

Over what level is Rx started?

Answer 5

Increased PR interval
Small/absent p waves
Widened QRS complex
Tall ‘tented’ T waves

Asystole if severe

> 6 mmol/L

VBG - can’t wait 45 minutes for bloods

> 6.5 mmol/L

Question 6

Hyperkalaemia Rx:

First line - Calcium chloride/gluconate:

• Why is it given?
• For how long?
• How long is it effective for?

Second line - IV Insulin:

• How does this lower potassium?
• What does it need to be given with?

Answer 6

It is cardioprotective

5-10 mins

Insulin stimulates intracellular uptake of potassium, lowering serum potassium

Needs to be given with 25g of glucsoe

Question 7

Hyperkalaemia Rx:

Third line - Salbutamol:

• How does this lower potassium?
• What may limit the use?

Fourth line - RRT:
- When is it indicate?

Answer 7

Causes intracellular potassium shift but high doses are required.

Underlying pathology cannot be corrected

Question 8

AKI Screen:

Urine, bloods, renal US and biopsy are done.

A myeloma screen is included.

What does this involve? - 4

What should you test for to identify vasculitis ? - 2

What should be tested for autoimmune diseases? - 3

Answer 8

Blood film
LDH
Serum free light chains
Serum electrophoresis

ANCA
Anti-GRM

Immunoglobulins
Rhematoid factor
Antiphospholipid antibody