AKI

Question 1

What are the risk factors for AKI

Answer 1

Acutely ill patients and those undergoing surgery

Chronic kidney disease
Heart failure
Diabetes
Liver disease
Older age (above 65 years)
Cognitive impairment
Nephrotoxic medications such as NSAIDS and ACE inhibitors
Use of a contrast medium such as during CT scans

Question 2

What is the definition of AKI

Answer 2

Acute drop in kidney function

Diagnosed by measuring serum creatinine

Question 3

NICE Criteria for AKI

Answer 3

Rise in creatinine of ≥ 25 micromol/L in 48 hours

Rise in creatinine of ≥ 50% in 7 days

Urine output of < 0.5ml/kg/hour for > 6 hours

Question 4

Pre-renal causes of AKI

Answer 4

Inadequate blood supply due to:

• Dehydration
• Hypotension (shock)
• Heart failure

Question 5

Renal causes of AKI

Answer 5

(Intrinsic disease of kidney - leading to reduced filtration of blood)

Glomerulonephritis
Interstitial nephritis
Acute tubular necrosis

Question 6

Post-renal causes:

Answer 6

Obstruction to outflow:

• Stones
• Masses in abdo/pelvis (e.g. cancers)
• Ureter or strictures
• Enlarged prostate or prostate cancers

Question 7

Findings on urinalysis: (AKI)

Answer 7

• Leukocytes and nitrites suggest infection
• Protein and blood - suggest nephritis (can also be positive in infection)
• Glucose - suggests diabetes

Question 8

imaging for aki:

Answer 8

ultrasound urinary tract to look for obstruction

Question 9

Management of AKI

Answer 9

Avoidance - achieved by avoiding nephrotoxic medications where possible and ensuring adequate fluid input

1. fluid rehydration (IV fluids) - Pre-renal
2. Stop nephrotoxic medications (NSAIDs/ antihypertensives that reduce filtration pressure)
3. Relieve obstruction - in post-renal AKI

Question 10

electrolyte imbalance in AKI

Answer 10

Hyperkalaemia

Question 11

Complications of AKI:

Answer 11

Hyperkalaemia

Fluid overload, heart failure and pulmonary oedema

Metabolic acidosis

Uraemia (high urea) can lead to encephalopathy or pericarditis