AKI lecture Flashcards

1
Q

What key parts should we ask about in HPC section of a history taken from the patient with AKI? (key symptoms)

A

HPC:

  • Events preceding illness
  • Hydration status
  • Urine output
  • Obstructive symptoms
  • Possible focus of infection
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2
Q

What to ask in Symptoms of vasculitis/**autoimmune disease in Hx of AKI patient?

A

Symptoms of vasculitis/autoimmune disease

  • uveitis
  • epistaxis
  • hearing loss
  • sinusitis
  • mouth ulcers
  • haemoptysis
  • bloody diarrhoea
  • joint pain
  • rash
  • anorexia
  • weight loss
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3
Q

Hx taking from pt presenting with AKI. What to ask for in PMH?

A
  • Risk factors for AKI
  • Renal disease
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4
Q

What elements of examination of pt with AKI to focus on?

A
  • Pulse / BP / SaO2
  • Urine output
  • Hydration status
  • Palpable bladder
  • loin tenderness
  • Evidence of systemic illness
  • I​nfective focus
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5
Q

The general approach to finding the cause of AKI

A
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6
Q

Indications for renal biopsy (3)

A

Renal biopsy

  • suspicion of vasculitis
  • likely intrinsic disease
  • unexplained / not recovering
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7
Q

What bloods to perform in AKI Ix?

A
  • U&E
  • HCO3, Ca2+ profile
  • LFTs
  • FBC
  • Clotting
  • ESR
  • Immunoglobulins / electrophoresis
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8
Q

What (other then bloods) Ix to do in AKI?

A
  • MSSU (mid stream specimen urine)
  • PCR/ ACR
  • ECG
  • CXR
  • USS kidney/ bladder
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9
Q

What ‘renal screen’ in investigations consist of?

A

Renal Screen

  • ANCA, Anti GBM, ANA, dsDNA, Complement
  • CK Blood cultures
  • blood film
  • cryoglobulins (specific immunoglobulins)
  • PSA
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10
Q

Risk factors for AKI

A

Risk factors for AKI include:

  • chronic kidney disease
  • other organ failure/chronic disease e.g. heart failure, liver disease, diabetes mellitus
  • history of AKI
  • use of drugs with nephrotoxic potential (e.g. NSAIDs, aminoglycosides, ACE inhibitors, angiotensin II receptor antagonists [ARBs] and diuretics) within the past week
  • use of iodinated contrast agents within the past week
  • age 65 years or over
  • oliguria (urine output less than 0.5 ml/kg/hour)
  • neurological or cognitive impairment or disability, which may mean limited access to fluids because of reliance on a carer
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11
Q

Signs and symptoms of AKI

A

Many patients with early AKI may experience no symptoms

As renal failure progresses the following may be seen:

  • reduced urine output
  • pulmonary and peripheral oedema
  • arrhythmias (secondary to changes in potassium and acid-base balance)
  • features of uraemia (for example, pericarditis or encephalopathy)
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12
Q

Management of AKI

A
  • adequate hydration
  • correction of hypotension – fluid -> Inotropic support
  • aAppropriate level of care
  • Exclude obstruction
  • treat underlying causes e.g. sepsis
  • stop / avoid nephrotoxins
  • monitor input/output
  • treat complications
  • renal referral
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13
Q

What are indications for dialysis in AKI?

A

Indications for dialysis:

  • hyperkalaemia
  • pulmonary oedema
  • uraemic encephalopathy
  • uraemic pericarditis
  • severe metabolic acidosis
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14
Q

What’s hyperkalaemia?

A

Serum Potassium > 5.5mmol/L

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15
Q

What’s hyperkalaemia?

A

Serum Potassium > 5.5mmol/L

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16
Q

What is the cause of hyperkalaemia in AKI?

A

Result of either

  • increased release from cells
  • decreased excretion – 90% excreted by kidneys
17
Q

What are (2) major consequences of hyperkalaemia?

A
  • lower cell-resting action potential -> delays conduction
  • muscle weakness -> paralysis
  • cardiac conduction abnormalities -> arrhythmias and cardiac arrest
18
Q

ECG changes in hyperkalaemia: with potassium level of 6-7

A
19
Q

ECG changes in hyperkalaemia, with a potassium level of 7-8

A
20
Q

ECG changes in hyperkalaemia with a potassium level of 8-9

A
21
Q

ECG changes in hyperkalaemia with potassium level of 9 or above

A

Sine wave pattern

22
Q

(3) treatment strategies of hyperkalaemia

A

Treatment strategies

1. Stabilising cardiac cell membrane -> calcium gluconate

2. Driving extracellular K+ into cells -> combined insulin/dextrose infusion & Nebulised salbutamol

3. Removing excess K+ from the body:

  • Calcium resonium (orally or enema)
  • Loop diuretics
  • Dialysis
23
Q

Treatment of Pulmonary Oedema

A
  • IV Furosemide
  • IV GTN
  • CPAP

*all may buy time until dialysis possible

24
Q

F L U I D (mnemonic in Mx of AKI)

A
25
Q

Do we do an early/prophylactic dialysis in AKI?

A

No evidence for early/prophylactic dialysis

* decision is individual to the patient

* no agreed biochemical threshold

26
Q

What type of dialysis is usually done in acute situation (e.g. AKI)?

A
27
Q

Does AKI increase the risk of CKD?

A

Yes. The more severe AKI -> the more increased risk of CKD

28
Q

What to do/advice post-discharge after AKI?

A