AKI teaching Dr Pickering Flashcards
What is an AKI?
- Acute impairment of excretory filtration function of kidney
- Causes change in eGFR
Measuring AKI
- Serum creatinine
- Inulin clearance
- 24hr creatinine
- Cr 51 EDTA
What is clearance?
- Apparant blood volume cleared per unit of time
CKD vs AKI
- CKD usually at least 3-6 months of these readings
- AKI significant increase in serum creatinine compared to baseline over hours to days
Signs/symptoms of CKD vs AKI
CKD - NONE - diagnosis is biochemical tests
AKI - NOT urine output - can have AKI with normal urine output
Classifying AKI
- Obstetric (eg pre-eclampsia, HELP syndrome) vs Medical vs Surgical
- Pre/intrinsic/post renal
What is HELLP syndrome?
HELLP syndrome is a combination of features that occurs as a complication of pre-eclampsia and eclampsia. It is an acronym for the key characteristics:
- Haemolysis
- Elevated Liver enzymes
- Low Platelets
Causes of post renal AKI
- Kidney stones
- Urethral strictures
- BPH
- Transitional cell carcinoma - ureter/bladder
- Prostate carcinoma
- Solid organ tumour - gynae, rectal carcinoma, sarcoma
- Lymphoma of pelvis
- Papillary necrosis
- Blood clots/pus
- Retroperitoneal fibrosis
Will you see retroperitoneal fibrosis causing dilatation on USS?
NO - encases ureters so you wont see them
How to detect post renal AKI?
- Image pelvis - USS KUB
Pre-renal AKI causes
AKA Hypoperfusion of kidney
* Sepsis
* Heart failure
* V+D
* Haemorrhage
* Burns
* Ascites
* Renal artery stenosis
* Thrombosis of renal artery
Places for hidden bleeding to occur to cause pre-renal AKI
- Peritoneal
- GI
- # NOF
Treatment for pre-renal AKI
FLUIDS
Causes of intrinsic renal AKI
- Acute tubular necrosis
- Glomerulonephritis
- Vascular - HTN, haemolytic uraemic syndrome
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What is ATN?
- Damage to kidney cells
- Consequence of hypoperfusion
- Now have to support kidneys as they recover
