AKI Flashcards
What are the NICE criteria that define AKI? (3 things)
- Creatinine rise of 25+ micromol/L in 48 hrs
- Creatinine rise of 50+% in 7 days
- Urine output of 0.5– ml/kg/hr for 6+ hrs
Any 1 of dem = AKI
What are the Risk Factors for AKI? (7 things)
- Age (65+)
- CKD
- HF
- DM
- Liver disease
- Nephrotoxic medications (NSAIDS / ACEi / ARBs / Diuretics like Spironolactone / Aminoglycosides)
- Iodinated contrast medium in CT scans
What are the 3 types of causes of AKI?
- Pre-renal
- Instrinsic
- Post-renal
What is the most common Type of cause of AKI?
Pre-renal
What are the Pre-Renal causes of AKI? (4 things)
- Reduced CO (Cardiogenic Shock / MI)
- Reduced blood volume (Haemorrhage / DnV / Pancreatitis)
- Systemic Vasodilation (Sepsis)
- Renal Vasoconstriction (NSAIDs / ACEi / ARBs)
What are the Instrinsic causes of AKI? (3 things)
- Glomerular (GN / ATN)
- Interstitial (Drug reaction / Inf)
- Vasculitis
What are the Post-Renal causes of AKI? (2 things)
- Within Renal Tract (Stone / Stricture / Clot / Cancer)
- Extrinsic Compression (Pelvic Cancer / BPH)
What are the CF of Pre-Renal AKI? (6 things)
Dehydration + Hypovolaemia:
- Postural hypotension
- Dizziness
- Thirst
- Prolonged cap refill
- Reduced skin turgor
- Reduced urine output
What are the CF of Intrinsic AKI? (6 things)
- Glomerular: Nephrotic / Nephritic Syndrome
- Interstitial (e.g Acute Interstitial Nephritis) : Fever / Arthralgia / Rashes / Eosinophilia
What are the CF of Post-Renal AKI? (8 things)
- Urinary Stones: Loin-groin pain / Haematuria / N+V
- BPH: Dysuria / Frequency / Dribbling
- Bladder Neck Obst: Palpable Bladder / Tender Suprapubic Area
What investigations should you do for sus AKI? (4 things)
- Urinalysis
- US / CXR / Renal Doppler / MRA
- ECG
- Bloods
What will results of Urinalysis suggest in sus AKI?
- Leucocytes / Nitrites = Inf
- Protein + Blood = Acute Nephritis / Positive Infection
- Glucose = Diabetes
What are you looking for in CT of sus AKI?
Obst uropathy (e.g. hydronephrosis)
What are you looking for in CXR of sus AKI?
Signs of fluid overload
What are you assessing in Renal Doppler of sus AKI?
Renal vascular assessment
What are you asessing in MRA (MR Angiography) of sus AKI?
Renal vascular assessment
What are the management options for AKI? (4 things)
- Pre-Renal: IV Fluid rehydration
- Post-Renal: Relieve obst (e.g catheter for pt w retention bc enlarged prostate)
- Stop Nephrotoxic Meds (e.g ACEi / NSAIDs / Spironolactone)
- Manage complications
- Renal Replacement Therapy
What are the complications of AKI? (4 things)
- Hyperkalaemia
- Metabolic acidosis
- Fluid overload / HF / Pulmonary Oedema
- Uraemia –> Encephalopathy / Pericarditis
What will you see on a ECG of Hyperkalaemia? (4 things)
- Small / Absent P wave
- Increased PR interval
- Widened QRS complex
- Tall “tented” T waves
Why is Hyperkalaemia important to know about?
MEDICAL EMERGENCY
What are the management options for Hyperkalaemia? (3 things)
- Calcium gluconate: Protects myocardium
- Insulin / Salbutamol (Beta Agonist): Drives Potassium back into intracellular compartment
- Stop Potassium Sparing / Containing meds (e.g Spironolactone)
Why does Metabolic Acidosis occur in AKI?
Bc kidney responsible for Acid-Base balance but impaired in AKI
What are the management options for Metabolic Acidosis? (2 things)
- Sodium bicarbonate
- Dialysis
What causes Fluid Overload in AKI? (3 things)
- Aggressive Fluid resus treatment
- Oliguria
- Sepsis (bc increased capillary permeability)
What are the management options for Fluid Overload? (4 things)
- Oxygen if needed
- Fluid restriction
- Diuretics (only if symptomatic) (careful bc nephrotoxic)
- Renal Replacement Therapy
What are the indications for Renal Replacement Therapy in AKI?
All 4 AKI complications not responding to meds
What are the complications of Renal Replacement Therapy? (3 things)
- Procecdural Hypotension
- Bleeding bc need anticoag req
- Altered drug clearance
