AKI

Question 1

AKI definition

Answer 1

Creatinine rise >26µmol/L within 48h
Creatinine rise >1.5x baseline within 7d
Urine output <0.5mL/kg/h for >6h consecutive

Question 2

AKI stages

Answer 2

1 - >26.5µmol/L creatinine or 1.5-1.9x baseline // <0.5mL/kg/h urine for 6-12h

2- 2.0-2.9x baseline creatinine // <0.5mL/kg/h for >12h

3- >353.6µmol/L or >3x baseline or RRT // <0.3mL/kg/h for >24h or anuria >12h

Question 3

AKI commonest causes

Answer 3

Drugs

Sepsis
Cardiogenic shock
Hypovolaemia

HRS
Obstruction
Major surgery

Question 4

AKI aetiology classification

Answer 4

Pre-renal (hypovolaemia, decreased CO)
Renal (glomerular, interstitial or vessels)
Post-renal (renal tract obstruction, extrinsic compression)

Question 5

AKI management common goals

Answer 5

Manage fluid balance, hyperkalaemia, acidosis

RRT when needed

Question 6

Assessing volume status AKI

Answer 6

See if overloaded, hypovolaemic
Don’t wait for decreased BP/ cap refill changes as these are late signs
Beware increased extra-vascular volume

Question 7

Hypovolaemia AKI management

Answer 7

Give crystalloid 500ml over 15 min
Further 250-500ml boluses after evaluation each time
Stop when euvolaemic or expert help when 2L given

Question 8

Crystalloid considerations AKI

Answer 8

0.9% saline may cause hyperchloraemic acidosis as contains Cl-
Hartmann’s/Ringer’s lactate contain K+ so beware in hyperkalaemic/an/oliguric pts

Question 9

Hypervolaemia AKI management

Answer 9

O2 if required
Fluid restriction
Diuretics in symptomatic overloaded
RRT if overloaded with oligo/anuria

Question 10

Acidosis definitions

Answer 10

Mild 7.3-7.36
Moderate 7.2-7.29
Severe <7.2

Question 11

Acidosis management AKI

Answer 11

If sodium bicarb given (very controversial so don’t use) CO2 generated so adequate ventilation needed
NaHCO3 also may make volume overload worse
Cause must be treated
RRT if needed

Question 12

Hyperkalaemia management AKI

Answer 12

Use blood gas, lab result takes too long
K+ >6.5mmol/L or ECG changes needs treatment
10ml 10% CaCl2 IV is cardioprotective for 30-60mins
IV 10u insulin in 25g glucose and monitor hourly for hypoglycaemia
Salbutamol 10-20mg via nebuliser can be used if not tachycardic
RRT if K+ can’t be removed

Question 13

RRT indications in AKI

Answer 13

Fluid overload unresponsive to medical treatment
Severe/prolonged acidosis
Recurrent/persistent hyperkalaemia
Uraemia