AKI Flashcards
pre renal causes of AKI
NB THESE ARE THE MOST COMMON CAUSES
think causes of hypoperfusion/hypotension/slower filtration
- dehydration
- D+V
- haemorrhage
- oedematous states (HF, cirrhosis, nephrotic syndrome)
- sepsis
- cardiogenic shock
- drugs: NSAIDs, ACEis,
- renal artery stenosis
renal causes of AKI
- Glomerular disease
- Acute tubular necrosis
- Nephrotoxins (e.g. contrast
- Acute interstitial nephritis (NSAIDs, infection)
- Vasculitis
- Malignant HTN
- Eclampsia
post renal causes of AKI
OBSTRUCTION
urethral stricture, BPH/pmalig, bladder malig, pelvic malig
px AKI
rise in serum creat oliguria N+V dehydration confusion
define oliguria
<0.5ml/kg/hr over six hrs
AKI defined as
Cr >=26.5 above baseline in 48h
Cr increased by 50% in preceding 7 days
-oliguric
THIS IS STAGE 1
what should you do if they are <0.5ml/kg/hr over 4 hours
still intervene as they are heading to AKI!! The point of this question is to show that you should shouldn’t wait till they have AKI before you treat
stats of AKI
10-20% of hospital admissions
30-60% ITU admissions
high risk of AKI
CKD diabetes diffuse atherosclerosis HF multiple myeloma elderly
NB risks factor + insult = v v high risk of aki!!
what cancer can often cause AKI
multiple myeloma - remember the case on minerva!
how to protect kidneys before radioactive contrast scan
stop risky meds
ensure still hydrate (possibly give fluids)
rx AKI
- ABCDE!!! (common problem in F1)
- urgently treat hyperkal
- treat cause
- monitor fluid and electrolyte balance
- fluid therapy (avoid overload by measuring UO)
- stop nephrotoxic drugs
- RRT if not responding to rx
what electrolytes ot monirot in AKI
creatinine na k ca phos gluc!!!
ix AKI
- urinalysis
- creat to assess renal function (cannot use egfr)
- U+Es. need ecg if K+ raised
- USS
- soluble immunology - to find cause if looks possible
- kidney biopsy
soluble immunology
complement
Ig electrophoresis
ANCA, anti GBM, glupus serology
what is rapidly progressing glomerulonephritis
nephritis + rapidly worsening renal function. not a diagnosis.
can be cuased by vascultiis, antiGBM disease, SLE, HSP
should fluid be given in AKI
you may think no because their kidneys aren’t working and therefore it would cause them to be fluid overloaded…BUT often kidney failure is caused by hypovolaemia so fluid will actually get the kidneys back working
you just need to be careful to monitor the urine output to check they aren’t retaining it all….especially in heart failure pts.
should furosemide be given in AKI
if overloaded, may need to increase dose
if dehydrates, need to stop dose.
therefore, you need to clinically assess everyone r AKI and furosemide
what are the DAMN drugs
diuretics, ACEi, metformin, NSAIDs
drugs that cause AKI
stages of AKI
1 cr 1.5x baseline, <0.5ml/kg >6hr
2 cr 2x baseline, <0.5ml/kg >12 hr
3 cr 3x baseline <0.3ml/kg >24 hr OR anuria >12 hr or RRT
what happens to the kidneys in sepsis/shock
poor flow causes AKI but also poor flow leads to poor perfusion of all kidney cells causing ACUTE TUBULAR NECROSIS
what do NSAIDs cause in kidney
acute interstitial nephritis
what can cause tubular toxicity
CONTRAST GENTAMICIN (this is the reason you are constantly checking gent levels)
