AKI Flashcards
Outline the serum creatine criteria for the staging of AKI according to KDIGO
Stage 1 - 1.5-1.9 times base line or >26micromol/L increase
Stage 2 - 2-2.9 times baseline
Stage 3 - Increase of 3 times baseline or increase in serum creatine >354micromols/L or initiation of RRT
Outline the urine output criteria for the staging of AKI according to KDIGO
Stage 1 - <0.5ml/kg/hr for 6-12 hours
Stage 2 - < 0.5mls/kg/ht for over 12 hours
Stage 3 - <0.3mls/kg/hr for over 24 hours or anuria for over 12 hours
Recall the components of the mnemonic SALFORD for the management of patients with AKI
S -Sepsis and other causes –> treat
A - ACE/ARBS and NSAIDS, suspend or review prescriptions
L - Labs (and leaflets for patient education)
F - Fluid assessment and response
O - Obstruction
R - Renal/ critical care referral
D - Dip the urine and record it
What are the 4 main causes of fluid overload?
- Iatrogenic
- Cardiac failure
- Renal failure
- Increased ADH secretion
Define Acute Kidney Injury
A clinical syndrome characterised by a rapid reduction in renal excretory function which can be due to a variety of causes.
Suggest 7 potential causes of pre-renal AKI
- Dehydration
- Shock
- Sepsis
- Hypotension
- Hepatorenal syndrome
- Severe heart failure
- Intra abdominal hypertension/ compartment syndrome
Suggest 9 potential causes of renal AKI
- NSAIDS
- ACEi
- ARBS
- Gentamicin
- GN/ Vasculitis
- Contrast
- Interstitial nephritis
- Myeloma
- Rhabdomyolysis
Suggest 3 potential causes of post renal AKI
I.e caused by obstruction
- Prostate enlargement
- Renal stones
- Pelvic cancer
How is chronic kidney disease defined
eGFR consistently less than 60
Define hydronephrosis
Swelling of the kidney due to an abnormal build up of urine due to an obstruction
The presence of both blood and protein in a urine dipstick test may indicate what condition?
Glomerulonephritis
Name 4 medical complications of AKI which are considered indicators for dialysis
- Hyperkalemia
- Pulmonary oedema
- Metabolic acidosis
- Uraemic encephalopathy or uraemic pericarditis
85% of AKI’s are associated with what ateiological subsection
Pre-renal
Outline the 3 phases of acute tubular necrosis
- Oliguric phase
- Maintenance phase
- Polyuric recovery phase
Define sepsis
Life threatening organ dysfunction caused by a dysregulated host response to infection.
What is the initial treatment regime for fluid resuscitation?
- Identify cause of deficit and respond
2. Fluid bolus of 500mls crystalloid over less than 15 minutes
If a patient does not respond to an initial bolus for fluid resuscitation, what total volume of fluid is it appropriate to give before seeking expert advice?
Repeat doses of bolus 500mls crystalloid over less than 15 minutes can be given until a maximum volume of 2000mls has been administered.
Outline the normal daily fluid and electrolyte requirements needed as part of maintenance fluid
- 25-30ml/kg/d water
- 1 mmol/kg/day sodium, potassium and chloride
- 50-100 g/day glucose
Outline the general physiological distribution of 42L of total body water throughout the body.
Intracellular fluid - 28L
Extracellular fluid - 14L
The extracellular fluid compartment can be further subdivided into:
Interstitial - 9L
Plasma/transcellular - 5L
Define the term ‘tonicity’ with reference to fluid shift
The relative osmolality between 2 fluid compartments
In what subgroup of patients is starch based colloid fluids contra-indicated in?
Surgical patients due to the risk of AKI and bleeding
Recall the 5 R’s of fluid prescription
- Resuscitation
- Routine maintenance
- Replacement
- Redistribution
- Reassessment
What are the 4 circumstances that a patient with an AKI requires discussion with the renal team?
- All patients with a renal transplant
- All patients with an AKI 3
- All AKI (stage 1,2 or 3) with protein and blood on urine dipstick
- All patients with no known cause of their AKI and with deteriorating renal function
Suggest 3 clinical means of removing potassium from the body
- Loop diuretics
- Dialysis
- Calcium resonium (orally or via enema)
Name 5 medications that must be stopped in patients with AKI as they risk further deterioration of renal function
- NSAIDS
- Aminoglycosides
- ACE inhibitors
- ARBs
- Diuretics
A poor response to fluid challenge is most characteristic of what type fo AKI aetiology?
Acute tubular necrosis
