AKI

Question 1

what is the definition of AKI?

Answer 1

a syndrome of dcreased renal function, measured by serum creatinine or urine ouptut, occuring over hours to days

Question 2

how can AKI be diagnosed based on creatinine and urine output?

Answer 2

• rise in creatinine >26mmol/l within 48hrs
• rise in creatinine >1.5x the baseline within 7 days
• UO <0.5ml/kg/hr for more than 6 consecutive hours

Question 3

what are the stages of AKI?

Answer 3

stage 1 = creatine 1.5-1.9 x baseline
= <0.5ml/kg/hr for 6-12 hours

Stage 2 = Creatinine 2.0-2.9 x baseline
= <0.5ml/kg/hr for >12 hours

Stage 3 = Creatinine >3.0 x baseline
= <0.3ml/kg/hr for >24 hours
= anuria for >12 hours

Question 4

what are the pre-renal causes of AKI?

Answer 4

decreased vascular volume

• haemorrhage
• D&V
• burns
• pancreatitis

decreased CO

• cardiogenic shock
• MI

systemic vasodilation
- sepsis

renal vasoconstriction

• NSAIDS
• ACEi
• ARB
• Hepatorenal syndrome

Question 5

what are the renal causes of AKI?

Answer 5

Glomerular

• glomerulonephritis
• Acute tubular necrosis

Interstitial

• Drug reaction
• infection
• infiltration e.g sarcoid

Vessels

• vasculitis
• HUS
• TTP
• DIC

Question 6

what are the post-renal causes of AKI?

Answer 6

within renal tract

• stone
• malignancy
• stricture
• clot

Extrinsic compression

• pelvic malignancy
• prostate hypertrophy

Question 7

what drugs should be withheld in AKI?

Answer 7

remember DAMN

Diuretics
ACEi/ARB
Metformin
NSAIDS

Question 8

uraemic symptoms can occur in severe AKI. What are they?

Answer 8

confusion
vomiting
acute pericarditis
metabolic acidosis

Question 9

what InV should be done in AKI?

Answer 9

Basic metabolic profile

• increased U+C
• hyperkalaemia
• metabolic acidosis

Serum K+
- hyperkalaemia

FBC

• WCC increase in sepsis
• anaemia secondary to HUS, myeloma, vasculitis

Blood and urine culture, urinalysis

catheterisation and UO monitoring

ECG - hyperkalaemia changes

Question 10

what are the management prinicples in AKI?

Answer 10

fluid resuscitation
- crystalloid

Recognise and prevent acidosis

Hyperkalaemia treatment

• IV calcium gluconate
• IV insulin and dextrose
• Salbutomal nebs

Renal replacement therapy

Question 11

what are the indications for RRT in AKI?

Answer 11

fluid overload unresponsive to treatement

Severe or prolonged acidosis

Recurrent/persistent hyperkalaemia

Uraemia