AKI

Question 1

What is an AKI

Answer 1

rapid fall in glomerular filtration
and
rapid rise is creatinine and urea i

Question 2

who gets an AKI

Answer 2

• old people
• septic patients
• diabetics
• patients with CKD
• patients with hypertension
• patients on nephrotoxic meds e.g. ACEi, NSAIDs

Question 3

what are the 3 types of AKI

Answer 3

Pre-renal (most common):

• inadequate blood supply to the kidney
• e.g. dehydration, heart failure

Renal:

• Intrinsic disease of the kidney
• e.g. glomerulonephritis, acute necrosis

Post-renal:

• obstructive uropathy causing back flow of pressure into the kidney
• e.g. kidney stones, cancer, strictures, BPH

Question 4

give causes of an AKI for each of the 3 types

Answer 4

Pre renal:

• dehydration
• hypotension
• heart failure

Renal:

• glomerulonephritis
• acute necrosis

Post-renal:

• kidney stones
• cancer (bladder/ ovarian/ prostate)
• ureter strictures
• enlarged prostate

Question 5

why is an AKI dangerous (pathogenesis)

Answer 5

acute reduction in renal function stops the body from being able to remove toxins and regular body functions

so accumulation of K+, fluid, H+ and urea

Question 6

how does an AKI present

Answer 6

• anuria/ oliguria
• malaise, fatigue, confusion
• n and v
• arrythmias
• dyspnoea
• oedema
• suprapubic pain
• haematuria

Question 7

what signs would you see OE in an AKI

Answer 7

in hypovolaemia:

• dry mucous membranes
• decreased skin turgor
• low BP

in volume overload:

• bibasal crackles
• raised JVP
• peripheral oedema

palpable bladder OE

Question 8

how do you investigate an AKI

Answer 8

ABG to look for acidosis

bloods to check renal function

ECG shows hyperkalaemia (tall, tented T waves)

Urinalysis:

• leukocytes/ nitrites present= infection
• protein/ blood= acute nephritis/ infection
• glucose= diabetes

USS to look for obstruction if post renal

Question 9

how do you manage an AKI

Answer 9

ABCDE approach- check for pulmonary oedema

pre renal= fluid rehydration

post renal= relieve obstruction

stop any nephrotoxic meds

Question 10

what are the complications of an AKI

Answer 10

Hyperkalaemia

metabolic acidosis

uraemia (high urea)

cardiac failure if in fluid overload

Question 11

how do you treat CKD

Answer 11

treat complications:

oedema-> fluid and salt restriction in diet, furosemide

anaemia-> subcut EPO (kidneys make it)

hyperkalaemia-> restrict K+ in diet and give sevelamer and alfacalcidol