AKI Flashcards
What is AKI?
- Syndrome of decreased renal function
- Acute onset
- Measured by serum creatinine and urine output
In what patients does AKI commonly occur?
ICU patients
What are causes of AKI?
- Sepsis
- Major surgery
- Cardiogenic shock
- Hypovolaemia
- Drugs
- Hepatorenal syndrome
- Obstruction
What are risk factors for AKI?
- Pre existing CKD
- Age
- Male
- Co-morbidity
How do you diagnose AKI?
- Creatinine > 26 within 48h OR 1.5x baseline in 7 days
- Urine output < 0.5 for 6h
What other investigations should you do in AKI?
- LFTs
- Platelets
- ANA + ANCA
- Anti-GBM
- US in 24h
When do you need to treat hyperkalaemia?
If K > 6.5 or ECG changes
How do you manage fluid balance in AKI?
Catheterise and measure urine output
How do you manage AKI?
- Sepsis 6
- Stop nephrotoxic meds
- H2 antagonist
- PPI
- Avoid radiological contrast
- RRT
What are the 3 types of AKI?
1) Pre renal
2) Renal
3) Post renal (obstruction to urine)
What happens in pre renal AKI?
Decreased perfusion to the kidney (decreased vascular volume, decreased CP, systemic vasodilation, renal vasoconstriction)
What are causes of pre renal AKI?
- Haemorrhage
- D&V
- Burns
- Pancreatitis
- NSAIDs
- ACE-I/ARB
- Aminoglycosides
What are causes of renal AKI?
- Glomerulonephritis
- Acute tubular necrosis
- Interstitial e.g. drug reaction, infection, infiltration e.g sarcoid
- Vasculitis
- DIC
What is acute tubular necrosis?
Prolonged renal hypoperfusion causing intrinsic renal damage
What are causes of post renal AKI?
- Intra-renal tract obstruction e.g. stone, malignancy, stricture, clot
- Extrinsic compression e.g. pelvic malignancy, prostatic hypertrophy, retroperitoneal fibrosis
