AKI Flashcards
Define Acute Kidney Injury
Significant decline in renal function over hours or days
manifesting as an abrupt and sustained ↑ in Serum Urea and Creatinine
What are the pre renal causes of AKI?
Most common cause
Hypovolemia
Shock
Renovascular compromise eg NSAIDs, ACEi
What are the renal causes of AKI?
Acute tubular necrosis - can be due to ischaemia, shock, HTN, direct nephrotoxins eg drugs - gentamicin/vancomycin, contrast
Tubulointersistial necrosis - drug hypersensitivity eg Penicillins, NSAIDs
Nephritic syndrome
What are the post renal causes of AKI?
SNIPPIN S - Stones N - Neoplasm I - Inflammation, stricture P - Prostate hypertrophy P - Posterior urethral valves I - Infection - TB, Schistomatous N - Neurological
How does AKI present?
Uraemia
Acidosis
Hyperkalaemia
Fluid overload - Oedema, BP changes, gallop rhythm (S3), Increased JVP
What are some of the signs of a GU tract obstruction?
Suprapubic discomfort Palpable bladder Enlarged prostate Catheter Complete anuria
Why is there an increase in osmolarity in pre renal failure?
The urine is concentrated causing more Na to be reabsorbed (
What is the RIFLE classification?
Grades/classifies AKI
What is the general management of AKI?
Identify and treat pre/post renal causes
Urgent USS
Treat any exacerbating factors eg sepsis
Stop any nephrotoxic drugs eg Gent/Vanc, NSAIDs, ACEi
Stop metformin if creatinine >150mM as risk of lactoacidosis
Why does renal failure cause lactoacidosis in patients with Metformin?
Lactoacidosis can occur due to metforming blocking gluconeogenesis causing an increase in lactate concentration as well as a reduced excretion of lactate due to renal impairment
What should be monitored in patients with AKI?
Urine output - catheterise
Central venous pressure
Fluid balance, Weight
What are the ECG features of Hyperkalaemia?
Peaked T waves Flattened P waves Increased PR interval Widened QRS interval Can eventually lead to VF
What is the management of Hyperkalaemia?
10ml 10% Calcium gluconate
100ml 20% dextrose + 10u insulin (Actrapid)
5mg Salbutamol nebs as can help with K uptake
What are the ECG features of Hypokalaemia?
Flattened T waves ST segment depression T wave inversion Prolonged PR interval Increased P wave amplification U waves present Pseudoprolonged QT interval
How can you manage acute pulmonary oedema associated with AKI?
Sit up and give high flow oxygen
125-250ml Frusemide IV over 1hr
2.5mg Morphine IV + antiemetic
Consider CPAP (Continuous positive airway pressure)
