AKI

Question 1

What is AKI?

Answer 1

Syndrome of reduced renal function occurring over hrs to days. It causes failure of fluid, electrolyte, and acid-base homeostasis.

Question 2

Define AKI (3)

Answer 2

Rise in creatinine >26umol/L within 48hrs.
Rise in creatinine >1.5x baseline within 7 days
Urine output <0.5 ml/kg/hr >6 consecutive hrs.

Question 3

Risk factors for AKI (9)

Answer 3

Pre-existing CKD
Age 
Male
Diabetes
CVD
Malignancy
Chronic liver disease 
Surgery

Question 4

Pre-renal causes of AKI:

1. Reduced vascular volume (4)
2. Reduced CO (1)
3. Systemic vasodilation (1)
4. Renal vasoconstriction (3)

Answer 4

Reduced perfusion to kidneys!!!

1. Haemorrhage. D+V. Burns. Pancreatitis.
2. Cardiogenic shock
3. Sepsis
4. NSAID, ACEi, hepatorenal syndrome

Question 5

Renal causes of AKI

1. Kidney
2. Vessels

Answer 5

Intrinsic renal disease!!!

1. Glomerulonephritis. Acute tubular necrosis
2. Vasculitis. HUS. TTP

Question 6

Post renal causes of AKI (5)

Answer 6

Renal tract: Renal stone, malignancy, stricture.

Extrinsic compression: Pelvic malignancy, BPH.

Question 7

Treatment system plan: (6)

Answer 7

1. Rule out life-threatening complications.
2. ABCDE assessment
3. If hypovolaemic = give fluids.
4. Monitor
5. Investigate.
6. Support

Question 8

Name the 3 life threatening complications to rule out?

Answer 8

Hyperkalaemia
Sepsis
Fluid overload - pulmonary oedema

Question 9

What things to monitor? (5)

Answer 9

1. Fluid balance
2. Potassium
3. vital signs
4. lactate if septic
5. Daily Creatinine.

Question 10

What things to investigate? (5)

Answer 10

1. Urine dipstick - heamaturia + proteinuria = intrinsic renal disease.
2. FBC - platelets for heamolysis (HUS/ TTP)
3. LFT - hepatorenal syndrome (hypoalbuminaemia).
4. Renal USS - no cause is found
5. Intrinsic renal disease = immunoglobulins, autoantibodies, paraproteins.

Question 11

What things to support? (4)

Answer 11

1. Tx sepsis
2. stop DAMN drugs
3. Medication review - check dosages.
4. Avoid radiological contrast.

Question 12

What information to gather during clinical exam and Ixs? (10)

Answer 12

1. Creatinine trend.
2. K
3. Lactate.
4. FBC
5. Urine dipstick
6. NEWS score.
7. Fluid input + output
8. O/e findings - hypo/hypervolaemia
9. Co-morbidities
10. Drugs - when and nephrotoxic?

Question 13

Features of hypovolaemia? (4)

Answer 13

Low BP
Low urine volume
Increased Heart rate
Daily weight loss

Question 14

Features of hypervolaemia (5) and Tx:

Answer 14

Increased BP 
Increased JVP
Lung crepitations 
Peripheral oedema
S3 sound. 
Tx: Oxygen, fluid restriction, diuretics is symptomatic

Question 15

ECG features of hyperkaelamia? (4)

Answer 15

Tall tented T waves
Increased PR interval
Small/absent P waves
Wide QRS complex

Question 16

Tx of hyperkalaemia? (2)

Answer 16

10ml of 10% calcium chloride over 10-15 mins 
IV insulin (drive K into cells) -> 2nd line - salbutamol -> 3rd line - renal replacement therapy.

Question 17

Indications for renal replacement therapy?

Answer 17

Fluid overload not responding to Tx
Prolonged/severe acidosis (metabolic acidosis)
Persistent/ recurrent high potassium
uraemic pericarditis/ encephalopathy.

Question 18

Treatment:

1. Pre-renal
2. Renal
3. Post renal

Answer 18

1. Fluids + Tx sepsis
2. Urine dipstick, biopsy, and refer to specialist
3. catheter, nephrostomy, urological intervention