AKI

Question 1

What are causes of “pre-renal” AKI?

Answer 1

Low blood pressure is the main cause:

• Hypovolumaemia (bleeding, diarrhoea and vomiting
• Cardiogenic shock
• Sepsis
• Drugs : NSAIDs and ACEI
• hepato-renal syndromes

Question 2

What are the “renal” causes of AKI?

Answer 2

Things that affect the kidneys itself:
- Gentamicin (nephrotoxic drugs) and NSAIDs
- Glomerulonephritis 
- Vasculitis
- Rhabdomyalysis
- HUS
....

Question 3

What are the “post-renal” causes of AKI?

Answer 3

Urinary tract obstructions:

• BPH
• Cancers from inside or outside the tube
• Tumour of the renal pelvis
• Kidney stones

Question 4

What are examination signs of hypovolaemia?

Answer 4

• Hypotension
• Tachycardia
• Decreased skin turgor
• Urine output and JVP

Question 5

How do you investigate post-renal causes?

Answer 5

Renal US- manifests as urinary tract dilataition and hydronephrosis -> sign of obstruction

• If kidney is small -> CKD
• If normal kidney size -> means it is not obstructed and the cause is likely to be a “renal CAUSE”

Question 6

How is AKI managed?

Answer 6

FLUID ASSESSMENT OF THE PATIENT IS KEY.

• If hypovolaemic: Fluid is given to hydrate
• If hypervolaemic and the kidneys cannot get rid of the excess fluid in the body, diuretics don’t work. IV nitrate might help by vasodilating BUT the definite treatment is “haemodialysis”.

Question 7

What is life threatening complication of AKI?

Answer 7

1- Hyperkalaemia- can result in VF and death. 
Tall tented T waves
Broad QRS
Absent P waves
Prolonged PR interal 

2- Metabolic acidosis- can lead to breathlessness
3- Pericarditis
4- Encephalopathy

Question 8

How is hyperkalaemia treated?

Answer 8

IV calcium gluconate
Calcium resonium (oral/rectal)
Insulin and glucose
Dialysis

Question 9

What are indications for immediate dialysis?

Answer 9

1- Pulmonary oedema (SoB as a sign- can’t give diuretics in AKI)
2- Pericarditis or encephalopathy
3- Hyperkalaemia >6.5
4- Acidotic pH <7.2