AKI Secondary to Surgery case

Question 1

What are the risk factors of developing an AKI post operatively

Answer 1

PREEXISTING CKD

Intraoperative hypotension
Bleeding post operatively, return to theatre
Urgent surgery
The use of a preoperative intraaortic balloon pump (inflates in diastole to improve coronary flow)
Blood transfusion

Peripheral vascular disease
Severe HF

Question 2

What is the prognosis of someone who has CKD and has a subsequent AKI

Answer 2

EPISODES OF AKI GREATLY INCREASE RISK OF CKD PROGRESSION

Question 3

What else may you find in the history that suggests that there is an AKI other than the risk factors
What may you find in the examination

Answer 3

If prerenal

• Poor urine output
• Dehydrated, dry mucous membranes
• Low JVP
• No peripheral edema

-no abdominal distention, pain, dull percussion

Question 4

What investigations may you initiate and why?

What may you find

Answer 4

Urea, creatinine

• raised
• for staging, compare to past renal function tests

Electrolytes
-depending on severity, may be hyperkalemic => do an ECG to check heart function

ABG
-metabolic acidosis with some respiratory compensation

Urinalysis

• if catheterised, blood may be as a result of catheter trauma
• any protein may be due to diabetic nephropathy

Hb
-anemic if CKD is severe

Question 5

What scans would you do, what might you find

Answer 5

ECG if hyperkalemic

• Spiked T waves
• loss of P waves

Renal USS

• loss of corticomedullary differentiation
• may be small if CKD severe
• if prerenal, no hydronephrosis

Question 6

How would you manage hyperkalaemia with evidence on the ECG

Answer 6

Calcium gluconate
Insulin, dextrose
K into cells, excretion
Address underlying cause

May requires RRT