AKI Flashcards
Accelerated HT
Diastolic Over 120
Medical emergency
Papilloedema, HF, fits, AKI
Extra-renal manifestations
Leukonychia (hypoalbuminaemia)
Mb in urine
Rhabdomyolysis - nephritic syndrome
Protein breakdwon
Excess exercise, trauma, dehydrated
CK raised
ECG in hyperkalaemia
Tall tented T waves No/flat P waves Long ST segment Sin waves VT -> VF -> asystole Can mean rhabdomyolysis
What is AKI?
Abrupt reduction in kidney function (less than 48 hours)
Increase in serum creatinine by 26.4
Increase in creatinine by 50%
Reduction in UO
Pre-renal causes of AKI
Hypovolaemia (haemorrhage)
Hypotension (shock)
Renal hypoperfusion (NSAID/ACEI/ARB)
What is pre-renal AKI?
Reversible volume depletion leading to oliguria and increased creatinine
Normal urine output
0.5ml/kg/hour
Oliguria
Less than 0.5ml/kg/hour
Effect of AT on efferent arteriole
Vasoconstricts = increased GFR
Effect of ACEI/ARB/diuretic/NSAID on efferent arteriole
Vasodilates = decreased GFR
Warn patients about sick day rules (diarrhoea/vomiting = stop taking meds)
Untreated pre-renal AKI leads to:
Acute tubular necrosis
What is acute tubular necrosis?
Commonest form of AKI in hospital
Decreased renal perfusion due to low BP/sepsis/dehydration/rhabdomyolysis/drug toxicity
Treatment of pre-renal AKI
Supportive: reverse cause (stop drugs, rehydrate, antibiotics), dialysis
Asses hydration
0.9% NaCl, NOT dextrose
What is renal AKI?
Diseases causing inflammation or damage to cells causing AKI
Causes of renal AKI
Vascular: vasculitis, renovascular disease
Glomerular: GN
Interstitial nephritis: drugs (NSAIDs, PPIs, antibiotics), infection (TB, sarcoid)
Tubular injury: ischaemia (prolonged hypoperfusion), drugs (gentamicin), contrast, rhabdomyolysis