AKI algorithm Flashcards

1
Q

Step 1
You have an elevated creatinine
Compare it to the baseline, is it and AKI or CKD?

A

Serum creatinine elevated at baseline/did not meet KDIGO definition of AKI => CKD

Serum creatinine >1.5x baseline or
Greater than 26.5umol/l or
Greater than 0.3 mg/dL in 48hours
Go to Step 2

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2
Q

Step 2
Is there a post renal cause
Do a kidney USS, is there an obstruction?

A

Obstruction present => post renal cause
-catheterise, investigate and address this

No obstruction => Step3

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3
Q

Step 3

Does the history, examination, investigations, urinalysis support a presently or intrinsic cause?

A

Prerenal cause => give IV fluid challenge
-if responsive, provide supportive therapy

If unresponsive => intrinsic cause
Go to Step 4

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4
Q

Step 4, suspected intrinsic cause
Perform a urinalysis and blood tests
Review past procedures

A

ATN if

  • ischemic
  • nephrotoxic drugs (aminoglycosides, contrast, statins)
  • myoglobin from rhabdomyolysis
  • muddy brown casts, proteinuria

Glomerulonephritis if

  • Antiglomerular basement membrane disease autoantibodies
  • ANCA antibodies found (cANCA, pANCA)
  • post infective
  • immune complex GN (lupus)
  • nephritic, nephrotic syndromes
  • RBC casts, proteinuria, fatty casts (if nephrotic)

Interstitial nephritis

  • drugs (NSAIDS, PPIs, penicillin)
  • local infection
  • systemic autoimmune disease (sjogrens, lupus)
  • WBC casts

Vascular
-obstruction from thromboembolism

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