AKI Flashcards
Pre-renal causes
- hypovolaemia secondary to diarrhoea/vomiting
- renal artery stenosis
Renal causes of AKI
glomerulonephritis
acute tubular necrosis (ATN)
acute interstitial nephritis (AIN)
rhabdomyolysis
tumour lysis syndrome
post renal causes of AKI
renal stone in ureter/ bladder
BPH
external compression of the ureter
Risk factors for AKI
- CKD
- other organ failure (e.g. heart, Diabetes)
- previous AKI
- nephrotoxic drug use
- contrast
- oliguria
- cognitive impairment
Symptoms/Signs of AKI
- reduced urine output
- pulmonary/peripheral oedema
- arrhythmias (electrolyte disturbance)
- features of uraemia
Definition of AKI
- creatinine rise >26 in 48 hours
- creatinine rise of >50% in the past 7 days
- urine output < 0.5 ml/kg/hour for >6 hours
Drugs which are ok to continue in AKI
Drugs which should be stopped in AKI to avoid worsening renal function
NSAIDs
Aminoglycosides (Gentamicin)
ACEi/ARB
Diuretics
Drugs that may have to be stopped as increased risk of toxicity (but don’t worsen AKI itself)
Metformin
Lithium
Digoxin
Hyperkalaemia management
- IV calcium gluconate (stabilises heart)
- Insulin/dextrose infusion +
Nebulised salbutamol (pushes K+ into cells) - Calcium resonium/ Loop diuretics/ Dialysis (remove K+ from body)
When is RRT used in AKI management
- patient is not responding to treatment of complications
e.g. hyperkalaemia, pulmonary oedema, acidosis or uraemia (pericarditis, encephalopathy)
What is meant by pre-renal uraemia?
kidneys hold on to sodium to preserve volume
=> low urine sodium
=> high urine osmolality
Pre-renal uraemia has a good response to fluid challenge. TRUE/FALSE?
TRUE
Describe the urine sodium and osmolality seen in acute tubular necrosis
high urine sodium
low urine osmolality
Creatinine 1.5 - 2x baseline
OR
Increase in creatinine by ≥26.5
OR
Reduction in urine output to <0.5 mL/kg/hour for ≥ 6 hours
Stage 1
