AKI 2 Flashcards
What are some of the drugs which can cause problems with the kidneys ?
- ACEi
- NSAIDS
- Gentamicin
- Trimethoprim
- Co-triamoxazole
What are the life-threatening complications of AKI ?
- Hyperkalaemia
- Fluid Overload (Pulmonary oedema)
- Severe Acidosis (pH < 7.15)
- Uraemic pericardial effusion
- Severe Uraemia (Ur >40)
What is the general mechanism causing post-renal AKI ?
AKI due to obstruction of urine flow leading to back pressure (hydronephrosis) and thus loss of concentrating ability
What are the causes of post-renal AKI ?
- Stones,
- Cancers,
- Strictures,
- Extrinsic Pressure
What is the appearance of the kidneys due to obstruction causing back pressure ?
Dilated renal pelvis - seen on US and CT
What is the treatment for post-renal AKI ?
Relieve obstruction:
- Catheter
- Nephrostomy - a tube that’s used to drain urine from a kidney into a bag outside the body
Refer to urology if ureteric stenting required
What is the worst complication of AKI that you need to watch out for ?
Hyperkalaemia
What are the signs of hyperkalaemia ?
Muscle weakness and tingling, cardiac arrhythmias
What are the K+ values of hyperkalaemia ?
- Hyperkalaemia = >5.5
- Life threatening hyperkalaemia = >6.5
What are the characteristic ECG changes seen in a patient with hyperkalaemia ?
- Peaked T waves (tall-tented)
- P waves become flattened
What is the initial treatment of hyperkalaemia ?
- Initially give calcium gluconate - to protect the myocardium
- Give insulin + dextrose (glucose) + nebulised salbutamol - to move K+ back into the cells
After doing the initial treatment of hyperkalaemia what would you do ?
Put the patient on dialysis
What are the indications for emergency dialysis ?
Hyperkalaemia:
- >7
- >6.5 unresponsive to medical therapy
Severe Acidosis - pH < 7.15
Fluid overload
Urea >40 or uraemic pericardial rub/effusion or encephalopathy
- A. Rhabdomyolosis
- B. Goodpasture’s Syndrome
- C. Acute Tubular Necrosis
- D. Obstructive Uropathy
- E. Wegener’s Granulomatosis
- 40 year old male presenting with general malaise & haemoptysis (Urea 28, Creatinine 600, elevated ant-GBM)
- 25 year old IVDA found collapsed at home
- 82 year old man admitted with BP 70 30, T 39, pulse 140bpm, K+ 7.0, urea 48, Cr 789, CRP 250, CXR left basal consolidation
- 72 year old man presenting with difficulty passing urine and reduced urine output
- B
- A – IVDU are at increased risk of rhabdomyolysis and compartment syndrome
- C
- D
Which of the following drugs do not cause hyperkalaemia?
- A. Spirolonolactone
- B. Ramipril
- C. Amiloride
- D. Furosemide
- E. Atenolol
- D
80 year old male admitted with 4-5 day history of diarrhoea. On admission BP 80 40, pulse 30bpm. Bloods phone back: Na 135, K+ 8.0, Urea 50, Cr 1000, Bicarb 9
Which of the following drugs would you administer first?
- A. insulin/dextrose
- B. Sodium Bicarbonate
- C. Salbutamol nebuliser
- D. Calcium Resonium
- E. Calcium Gluconate
- E – you stabilise the myocardium first
Which of the following is not an indication for emergency dialysis?
- A. Pulmonary Oedema (in context of AKI)
- B. Life threatening hyperkalaemia
- C. Uraemic Pericarditis
- D Elevated creatinine > 500
- E Severe Acidosis
- D
- What is AKI
- Why is it important
- Risk factors for AKI?
- Most common causes of AKI ?
- Name 3 nephrotoxic drugs
- What are the indications for emergency dialysis?
- Rise in creatinine, decrease in OU
- Poorer surivial, increased hospital stay
- Age, DM, CKD, co-morbidity
- Pre-renal – spesis, dehydration
- Gentamicin, NSAID, ACEi/ARB, radio contrast (PPI not really common so prob not classed as this)
- Fluid overload (oedema), Hyperkalaemia, Severe acidosis < 7.15, Urea >40, pericardial rub/effusion
If someone has an AKI and you are trying to rehydrate them what sort of fluid balance/status should you aim for in a 24hr period ?
They should be 500-1000mls +ve on fluid balance.
What can people develop post obstructive AKI (post-renal) when the obstruction has been relieved and what should you do to manage this ?
Some people may develop post-obstructive diuresis which is where the kidneys need time to start functioning again but during this period where they are not they are not able to reabsorb water effectively. Result is >200mls of urine produced every hour.
Management is to match 50% the output as input with IVF until patient stops diuresing.
