AKI

Question 1

AKI Aetiology (Prerenal, intrinsic and post-renal)

Answer 1

Prerenal

• Volume depletion
• Oedematous states
• Hypotension
• CV
• Renal hypo perfusion (NSAIDS or COX-2 inhibitors), AAA, stenosis or occlusion of renal artery

Intrinisic

• Glomerulonephritis, thrombosis, HUS
• Tubular injury (acute tubular necrosis)
• Acute interstitial nephritis
• Vasculitis

Postrenal

• Calculus
• Blood clot
• Papillary necrosis

Question 2

AKI RFs

Answer 2

• Age ≥65
• CKD
• PHx-Co-existing illness
• eGFR<60

Question 3

AKI Presentation

Answer 3

• Recognised by oliguria or anuria and a rise in creatinine
• Rise of 26 within 48hrs or 50% increases within previous seven days
• Or fall in urine output to less than 0.5ml/kg/hour
• Abrupt anuria suggests acute obstruction or occlusion of artery
• Gradual diminution indicates stricture or bladder outlet obstruction
• Hypertension
• Large painless bladder in chronic urinary retention
• Fluid overload with raised JVP

Question 4

AKI Staging

Answer 4

• Stage 1: 1.5-1.9 times reference value, <0.5ml for >6 consecutive hours
• Stage 2: 2.0-2.9x, <0.5ml for >12 hours
• Stage 3: 3x, <0.3ml for >24 hours

Question 5

AKI Differentials

Answer 5

-CKD

Question 6

Factors that suggest CKD

Answer 6

• Long duration of symptoms,
• Nocturia
• Absence of acute illness
• Anaemia
• Hyperphosphataemia
• Hypocalcaemia
• Reduced renal size and cortical thickness

Question 7

AKI Management

Answer 7

• No specific treatment
• Treat cause
• STOP AKI

Question 8

Indications for RRT

Answer 8

• If any of the following are not responding to treatment
• Intractable Hyperkalaemia
• Acidosis
• Uraemic symptoms (nausea, pruritus, malaise, particarditis, encephalopathy)
• Fluid overload
• CKD stage 5