Acute Kidney Injury (Medicine) Flashcards
Treatment of Hyperkalaemia
- Salbutamol Nebulisers
- 10u Actrapid in 50mls 50% Dextrose
- 500ml 1.26% NaHCO3 over 1 hour
- 10 ml of 10% of Calcium gluconate (only if ECG changes)
Measurement of Kidney Function
- Creatinine
- eGRF
- Urine Output
Scale of AKI problem
- AKI is common (10-20% hospitalised patients)
- a/w harm (need dialysis, peventable iatrogenic, 40% don’t survive)
- costly
- development of AKI is modifiable
Why do patients die of AKI in hospital?
- Delay in recognition of AKI in post-admission patients
- Poor assessments of risk factors of AKI
- Poor management of AKI
- Missed complications of AKI
Causes of AKI
Pre-renal (reduced renal perfusion)
- Hypotension
- Hepatorenal syndrome
- Renal Artery Stenosis
- Renal Artery clot
Renal
- Drugs (NSAIDS, ACEi, ARBs, Gentamicin)
- GN/Vasculitis
- Contrast
- Interstitial nephritis
- Myeloma
- Rhabdomyolisis
Post-renal (obstruction)
- prostate enlargement
- renal stones
- pelvic cancer
Percentage of AKI that is hospital acquired or Community acquired, and causes respectively.
Hospital acquired (50.3%) - Renal causes (Drugs)
Community acquired (49.7%) - Pre-renal causes
Big Risk Factor for AKI
Chronic Kidney Disease (CKD)
>50%
AKI Prevention
The risk of AKI is contributed to by the acute insult and background morbidity.
What are the acute insult and background morbidity?
Background morbidity
- Elderly
- CKD
- Cardiac failure
- Liver disease
- Diabetes
- Vascular disease
- Background nephrotoxic medications
Acute insult - Acute STOP Sepsis & Hypoperfusion Toxicity Obstruction Parenchymal Kidney Disease
What are STOP aki?
Sepsis & Hypoperfusion
- Severe sepsis
- haemorrhage
- Dehydration
- Cardiac failure
- Liver Failure
- Renovascular insults
Toxicity
- Nephrotoxic drugs
- Iodinated Radiological Contrast
Obstruction
- Bladder outflow
- Stones
- Tumour
- Surgical ligation of ureters
- Extrinsic compression (e.g lymph nodes)
- Retroperitoneal fibrosis
Parenchymal Kidney Disease
- GN
- TIN
- Rhabdomyolysis
- HUS
- Myeloma kidney
- Malignant Hypertension
Prevent AKI - The 4 M’s
- Monitor the patients
- Obs & EWS
- Regular fluids
- Maintain fluid charts
- assess urinary output and daily weights - Maintain circulation
- fluid resuscitation
- oxygenation - Minimise Kidney Insult
- Avoid NSAID’s Gentamycin, iodinated contrast - Manage Acute Illness
- recognise and treat sepsis promptly
- diuretics for hypervolaemia in heart failure. (not to maintain urine output)
What kind of things do you need to consider if one of your patients has CKD?
- Increased risk for AKI
- medication handling (if someone is anuric, their eGFR is 0ml/min, regardless of creatinine)
Recognising AKI early:
The AKI network Classification
Stage 1
Increase in serum creatinine >150-200% from baseline
Urinary output (UO) less than 0.5 ml/kg per h for >6 h
Stage 2
Increase in serum creatinine > 200-300%
UO less than 0.5 ml/kg per h for >12 h
Stage 3
Increase in serum creatinine >300%
UO less than 0.3 ml\kg for 24 h or anuria for 12 h
Recognising AKI early:
AKI identification
- Identify AKI (serum creatinine > 1.5 x basline) and presume normal baseline if no previous results available.
- clarify whether Dx likely to be pre-renal, renal or post-renal causes (can co-exist)
- Immune symptoms
rash, new arthritis, nasal crusting/bleeding, haemoptysis, new deafness, mouth ulcers, alopecia, iritis/episcleritis, mononeuritis multiplex or neuropathy - Obstructive symptoms/signs
poor stream, hesitancy, frequency, nocturia, PV bleeding, stones
Recognising AKI early:
AKI Examination
- Fluid status, BP, JVP, loin tenderness, palpable bladder, rash, oedema, signs of autoimmune disease
- Urine dipstick Must be done in all: AKI Non-dialysis CKD DVT or PE Oedematous patients Suspected UTI
- Everyone gets US Kidney to check size and outrule obstruction.
Dipstick results (Blood only) - differentials (4)
Trauma
Malignancy
Stones
Rhabdomyolysis
