AKI Flashcards
What intervention should be used in metabolic acidosis occurring as a result of AKI?
Renal replacement therapy.
What are the 10 functions of the renal system?
Water balance Electrolyte balance Acid-base balance BP maintenance Waste removal Toxin/drug removal Erythropoietin Calcium and phosphate balance Vit D3 synthesis Insulin degradation
What are 3 criteria in the diagnosis of AKI?
Increase in serum creatinine 26micromol/L within 48 hours.
Increase in serum creatinine >1.5 x above baseline within 1 week
UO of <0.5ml/kg/hr for >6hrs
What is the molecule looked for to assess AKI?
Serum creatinine
What are the diagnostic criteria for AKI stage 1?
Serum creatinine >26micromol/L in 48 hrs
UO <0.5ml/kg/hr for 6hrs
What are the diagnostic criteria for AKI stage 2?
Serum creatinine >2 x baseline
UO <0.5ml/kg/hr for >12hrs
What are the diagnostic criteria for AKI stage 3?
Serum creatinine >3 x baseline
UO <0.3ml/hr/kg for 24 hrs
Normal serum creatinine levels?
55-120umol/L
What are example baseline risks for AKI?
Older Diabetes mellitus Chronic kidney disease Heart failure Hypertension Liver failure Male Race Hypoalbuminaemia Arterial vascular disease
What are example acute risks of AKI?
Sepsis Hypotension Volume depletion Rhabdomyolysis Cardiac/vascular surgery Organ transplantation Compartment syndrome Mechanical ventilation
What are example nephrotoxic agents?
Contrast
Antibiotics
Chemotherapy
NSAIDs
What are example causes of intrinsic AKI?
Acute tubular injury: pro-longed pre-renal AKI; rhabdomyolysis; nephrotoxins
Glomerulonephritis
Vasculitis
What are example causes of post renal AKI?
Kindey stones
Prostatic hypertrophy
Tumours
Retroperitoneal fibrosis
What are example causes of pre-renal AKI?
Sepsis Hypovolemia Hepato-renal syndrome Cardiac failure Hypotension
What are examples of cardiac pre-renal AKI?
Heart failure Myocardial infarction Arrhythmia Pulmonary Embolism Shock Tamponade
What are examples of volume pre-renal AKI?
Haemorrhage GI loss Renal loss Skin loss Inadequate hydration Diuretics
What are examples of vasomotor factors pre-renal AKI?
Afferent constriction- sepsis, NSAIDs, hypercalcaemia
Efferent dilation- ACE inhibitors
What are examples of obstruction pre-renal AKI?
Thrombosis
Embolism
Hyperviscosity
What are the causes of intrinsic AKI?
Vascular
Glomerular
Tubular
Interstitial
What are the symptoms of AKI?
Decreased UO Fluid retention- oedema Dyspnoea Chest pain Hypertension Confusion Nausea/vomiting Seizures or coma in severe Mild back pain Cardiac arrhythmias- increased potassium Symptoms of the cause- thirst
What is uraemia?
Deterioration of biochemical, physiological functions as a result of retention of different solutes. Resembles systemic poisoning
What are vital sign symptoms of AKI?
Pulmonary oedema Dyspnoea Tachypnoea- metabolic acidosis Hypertension Hypertrigliceridaemia Nausea Constipation/diarrhoea
Haematologically what would you see in someone in AKI?
Anaemia
Platelet/WBC dysfunction
Increased oxidative stress
Inflamation- increased cytokine release
In relation to the skin, how does AKI manifest? And why?
Pruritis- itching due uraemic toxins
Dry skin- reduced sweat and secretion from sebaceous glands
Pigmentation- become yellow in colour due to urochrome building up in tissues
