AKI Flashcards
What are the pre-renal causes of an AKI?
Impaired blood flow to the kidney, and this may be a result of:
Hypovolaemia – which may be due to reduced blood volume
Hypotension
Decreased cardiac output
Vascular disease – limiting renal blood flow
Renal artery stenosis
What are the intra renal causes of an AKI?
Intrinsic renal pathology affecting:
glomerulonephritis
acute tubular necrosis (ATN)
acute interstitial nephritis (AIN), respectively
rhabdomyolysis
tumour lysis syndrome
What are the post renal causes of an AKI?
Obstruction to urinary outflow anywhere along the urinary tract:
Luminal blockage (e.g., a kidney stone)
Mural obstruction (e.g., a tumour in the urinary tract), External compression (e.g., benign prostatic hypertrophy).
What drugs should be stopped in an AKI
Stop those DAMN drugs.
D - diuretics and digoxin
A - ARB and ACEi
M - metformin and methotroxate
N - NSAIDS
What is the main complication to monitor in an AKI?
HypERkalaemia
What are the investigations for hyperkalaemia?
Blood test, ECG changes
Why is it important to treat hyperkalaemia in an AKI?
Muscle weakness, paralysis and CARDIAC ARRHYTHMIAS
How is hyperkalaemia treated?
If there are ECG changes:
Give 10ml of 10% calcium gluconate (or chloride) over 10 mins - this is cardioprotective (if ECG changes)
Intravenous insulin (10U soluble insulin) in 25g glucose (50mL of 50% or 125ml of 20% glucose) - prevents hypoglycaemia
Nebulised salbutamol - also causes intracellular K^+^ shift
What is the first choice NSAID for renal colic?
Diclofenac
What is the KDIGO classification of Stage 1 AKI?
Cr 1.5-1.9 times baseline, OR
Cr increase >0.3 mg/dL
Urine criteria
<0.5ml/kg/hr x 6-12 hours
What is the KDIGO classification of Stage 2 AKI?
Cr 2-2.9x baseline
Urine criteria
<0.5 ml/kg/hr for > 12 hours
What is the KDIGO classification of Stage 3 AKI?
Cr > 3x baseline, OR
Cr > 4 mg/ dL, OR
Initiation of dialysis
Urine analysis
<0.3 ml/kg/hr for >24 hours, OR
Anuria > 12 hours
