AKI Flashcards
AKI
What is an AKI characterised by?
a decline in renal excretory function over hours or days that can result in failure to maintain fluid, electrolyte, and acid-base homeostasis
https://patient.info/doctor/acute-kidney-injury-pro
AKI
What are the 3 categories of causes for AKIs?
Name 3 in each category.
Prerenal (the BODY is in extreme shock)
*major haemorrhage, burns, hypotension, renal hypofusion (iatrogenic), nephrotic syndrome
Intrinsic (very rare, the KIDNEYS are injured)
* glomerular
*glomerulonephritis,
- tubular
*acute tubular necrosis - interstitial
*acute interstitial nephritis - vascular
*vasculitis, renal artery stenosis, renal vein thrombosis, malignant hypertension - eclampsia
Postrenal (UROLOGICAL cause)
* obstruction of any sort
*BPH, stones, stricture, cancer
https://patient.info/doctor/acute-kidney-injury-pro
AKI
Name some risk factors for developing an AKI.
- CKD, HF, liver disease
- History of AKI, oliguria
- Drugs - NSAIDs, ACEi, diuretics
- obstructions
- sepsis
- age >65yo
AKI
How would a pt present? (Symptoms)
- urine output: oliguria/anuria
- nausea, vomitting
- dehydration
- confusion
AKI
How would a pt present? (Signs)
- pallor, rash, bruising
- hypertension
- dehydration or fluid overload w/ raised JVP
- pericardial rub
- large painless bladder
AKI
What bloods would you want to do for a pt with suspected AKI?
- FBC / blood film
- U&Es + creatinine
- coagulation studies
- creatine kinase, myoglobinuria
- CRP
- immunology (ANA for lupus)
https://patient.info/doctor/acute-kidney-injury-pro
AKI
What investigations would you want to do for a pt with suspected AKI?
- urinalysis (dipstick + osmolality)
- bloods
- USS
- other radiology
https://patient.info/doctor/acute-kidney-injury-pro
AKI
Name 3 differentials.
- CKD
- acute on chronic kindey disease
- sepsis
https://patient.info/doctor/acute-kidney-injury-pro
AKI
How is it staged?
Acute kidney disease staging according to the Kidney Disease: Improving Global Outcomes classification:
Stage 1:
Serum creatinine levels: 1.5-1.9-fold higher than baseline or increase ≥ 3 mg/L.
Urine output <0.5 ml/kg/hr for 6-12 hrs.
Stage 2:
Serum creatinine levels: 2-2.9-fold higher than baseline.
Urine output <0.5 ml/kg/hr for ≥12 hrs.
Stage 3:
Serum creatinine levels: 3-fold higher than baseline or increase ≥40 mg/L, or initiation of renal replacement therapy.
Urine output <0.3 ml/kg/hr for ≥24 hrs or anuria for ≥12 hrs.
https://patient.info/doctor/acute-kidney-injury-pro#nav-6
AKI
How to manage? (pre-renal)
- Get the fluid balance right
- Fluids if underfilled
- Offload if over filled – GTN and furosemide
AKI
How to manage? (intrinsic)
stop toxic agents
- NSAIDS
- Gentamicin
- ACEi/ARBS
- contrast
AKI
How to manage? (postrenal)
treat cause of obstruction
AKI
Indications to do a biopsy
- unexplained kidney injury with normal kidney size
- histology is likely to influence treatment
- histology is likely to offer prognostic info
- info concerning activity (and potential reversing) of previously identified lesion would be useful
AKI
Complete the acronym for pathologic basis of disease.
GDIIITTTNN
AKI
Describe the prognosis:
* overall prognosis
* what improves prognosis
* long term effects
* community vs hospital acquired
- poor
- early detection improves
- increased risk of aki again
- CA better than HA
