aki Flashcards
how many a year?
18% of hospital patients
480-630 million a year
what is it?
rapid reduction in renal function in recent days measured by serum urea and creatinine leading to a loss of maintenance of electrolyte, fluid and acid-base homeostasis balance.
three catergories of causes
pre-renal
intra-renal
post-renal
causes for pre-renal
hypoperfusion - hypovolaemic, sepsis vascular - r. atery stenosis, AAA Cardiac failure, arrythmias HRS burns bleeds
three medications which can cause pre-renal
ACEi COX2 nhibitors, NSAIDS
intra-renal causes
glomerulonephritis haemolytic ureamic syndrome thrombosis drugs!!! infection hypercalcaemia AI diseases- SLE, vasculitis thrombus, occlusion
post renal causes
stones clots malignancy BPH strictures fibrosis -retroperitoneal
risk factor
chronic kidney injury cardiac failure drugs over 75 years of age history of urinary symptoms BPH diabetes PVD CLD sepsis poor fluid intake
symptoms
poor urine output/reduced urination fatigue sweating nausea voiting dehydration confusion palpitations (hyperkalaemia) rash/bruising and joint swelling nightsweats fever weight loss
signs
increased respiratory rate bounding peripheral pulse low JVP sunke face - dehydration reduced skin turgor dry mouth pitting odema fluid overload on heart sounds cap refill over 2 sconds warm to touch but cold peripheries
differentials
chronic kidney disease
acute on chronic kidney disease
investigations
urine dipstick - blood, leukocytes, proten FBC - thrombocytopenia Uand E creatinine for function-- egFR coagulation screen blood cultures- sepsis virology immunology for antibiodies ABG- oxygenation and electeolyes imaging-USS for stones CXR-pul odema dopler studies for renal arteries MRI -vascular occlusion
treatment
ABCDE
cathertise patient and monitor urine output
antibiotics for sepsis
what criteria?
KDIGO
what does this criteria state?
stage 1 : > 26 u(with a tail)mol/L in 48 hours rise creatinine
or rise by 1.5x baseline
urine outpue is <0.5ml/kg/h over 6 hours
in children and young adults, drop by 25% in eGFR in past 7 days
stage 2
<0.5ml/kg/hr for 12 hr
2-3x baseline creatinine
stage 3 : anuria 15 hours
< 0.3ml/kg/hr for 24 hr
creatinine more than 3x baseline
