AKI Flashcards
What is acute kidney injury (AKI)?
Rapid reduction in kidney function over hours-days
What are the diagnostic criteria for AKI? (3)
- Creatinine > 26 micromol/L within 48h
- Creatinine > 50% baseline wihtin 7 days
- Urine output < 0.5 mL/kg/h > 6 hours
What are the risk factors for AKI? (4)
- Sepsis, shock
- Drugs
- Dec fluid intake/ inc fluid loss
- Major surgery
What are the clinical presentations for AKI? (4)
- Oliguria
- Anuria
- Poor tissue turgor
- Systemic: nausea, vomiting, confusion
How would a patient w fluid overload present? (3)
- Raised JVP
- Peripheral oedema
- HTN
What are the clinical features of an AKI emergency? (3)
HYPERKALEMIA
No urine production
Pulmonary oedema
What are the ECG changes for hyperkalemia? (3)
Tall, tented T waves
Small P
Long PR, ORS
How would you investigate AKI? (5)
Bloods: raised creatinine, may have anaemia
U&E: raised K+ and phosphate, low Ca+
Renal US: rule out blockage
NCCT-KUB, KUB XR
Urinalysis - dipstick: may have infection/ glomerular disease
Dipstick showing proteinuria and haematuria suggest what?
Intrinsic renal disease
How would you treat pre-renal AKI? (2)
Fluid balance = IV saline/ diuretics
Abx for sepsis
How would you manage hyperkalemia in AKI? (4)
Calcium gluconate (protects myocardium)
Insulin + dextrose
(Salbutamol nebuliser if glucose/insulin unsuccessful)
Calcium resonium (removes excess K+)
Why isn’t urea used as a measure of renal function?
Urea is secreted and reabsorbed by the kidneys so readings aren’t accurate
How would you manage AKI? (2)
Stop all nephrotoxic drugs
Monitor haemodynamic status
How would you manage pulmonary oedema in AKI? (3)
- O2
- Venous vasodilator
- Diuretics (furosemide)
What would you do if all treatment attempts fail in AKI?
Dialysis
