AKI - Acutr Medicine SA Flashcards
What conditions do you start seeing when the kidneys are not working properly?
***HYPERKALAEMIA*** Fluid overload Uraemia Hypertension Renal anaemia Mineral bone disorder(s) Metabolic acidosis
What biochemical parameters are required (in addition to clinical context) to make a diagnosis of AKI?
1.5 X rise in creatinine from baseline
OR
Oliguria (6hours
What is meant by the term “pre-renal” AKI?
A pre-renal AKI involves an essentially normal kidney that is responding to hypoperfusion, by decreasing the GFR.
What % of AKI’’s are caused by pre-renal problems?
40-70%!
What is meant by the the term “renal AKI”?
Intrinsic AKI. This refers to a condition in which the pathology lies within the kidney itself. This accounts for 20-50% of AKI’s.
What is meant by the term post-renal AKI?
This is OBSTRUCTION
Always palate the bladder. Always think of Prostate Ca in men.
A man presents to a and E feeling generally unwell. He has a background of CCF and chronic venous ulcers. He is confused. Obs are:
HR 75 BP 60/40 RR 22 SAO2 85% on Room air GCS 14/15 (confused)
What is your diagnosis?
Well the blood pressure in his boots is worrying. He has a cardiac history, which may mean he is on a beta blocker to suppress his compensatory tachycardia reflex. He is hyperventilating and not saturating well, which could potentially be because of an acidosis developing. HE has LEG ULCERS.
This man is in SEPTIC SHOCK
If someone arrives in septic shock, which team should you be considering contacting first, after escalation to seniors?
You should be contacting ITU.
INFO:
Source of sepsis What is the urine output? Is there any swelling or oedema or SOB? Is there evidence of uraemic syndrome (urea in the blood) Is the patient on any nephrotoxic meds? Any PMH or FH of renal disease? Any other symptoms and signs.
Which medications do you know are nephrotoxic, and should be stopped if a patient arrives with AKI?
Furosemide, Ramipril, Bisoprolol, Spironolactone
Diuretics: If dry then stop
Heart pills: If patient through floor then stop
Give some pre-renal causes of AKI
Sepsis
Dehydration
Nephrotoxics
Rhabdomyolysis
Which investigations should you use to try and work out the cause of an AKI?
Urine dip, MSU, PCR, BJP (Bence jones protein, used to identify multiple myeloma - think pancytopaenia)
Venous gas - Check bicarbonate, BE, and ph - is there a metabolic acidosis?
CXR - is this a pneumonia?
CK - IS this a long lie?
USS KUB - Look for obstruction
“Renal scree” (ANCA, anti-GBM, ANA, Complement, immunoglobulins, SPEP, RF eTC)
What kept features of an ECG are noted in hyperkalaemia ?
Tented T waves globally
Flattened p waves
Long QRS - slowed appearance of the QRS.
What can you use to treat hyperkalaemia?
Calcium gluconate 30 ml (peripheral vein)
or Calcium Chloride 10ml (central line as caustic)
This lasts about 30-60 mins and buys you time.
You can use Insulin (50ml 50% dextrose with 10-15 IU of actraid), and/or IV salbutamol too lock K in cells as a temporary measure, too. This will last 4-6 hours.
You can give bicarbonate to correct the acidosis, and furosemide or Spironolactone to eliminate K. Monitor carefully, as don’t want to drop TOO low!
A patient has come in with AKI. You do a gas and their base excess is very low. What does this tell you about them?
They are VERY dry!
Before administering bicarbonate, blood levels of which two things should be measured?
Calcium and Sodium.
