flashcards_aki
What does the acronym STOP AKI stand for in the management of AKI?
Sepsis, Toxins, Optimise volume status and blood pressure, Prevent harm.
What are the steps to take for ‘Sepsis’ in the STOP AKI protocol?
Perform a septic screen.
What should be done for ‘Toxins’ in the STOP AKI protocol?
Identify and stop nephrotoxic drugs (e.g., NSAIDs, aminoglycosides, iodine-based contrast agents).
How should volume status and blood pressure be optimized in AKI management?
If hypovolaemic, give bolus saline and withhold diuretics.
What reversible causes and life-threatening complications should be treated to prevent harm in AKI?
Treat reversible causes such as urinary tract obstruction and life-threatening complications such as acidosis and hyperkalaemia.
What is the management for pre-renal failure in AKI?
Address hypovolaemia urgently with fluid replacement and circulatory support. If haemorrhage, start major haemorrhage protocol. If sepsis, start sepsis 6 protocol.
What is the management for intrinsic renal failure in AKI?
For acute tubular necrosis, stop causative drugs (e.g., gentamicin). For glomerulonephritis, follow specific management protocols.
What is the management for post-renal failure in AKI?
Refer immediately to urology if pyelonephritis, obstructed solitary kidney, bilateral upper urinary tract obstruction, or complications of AKI caused by urological obstruction. Assess the site of obstruction and achieve relief by nephrostomy or bladder catheterisation.
When is dialysis indicated in AKI management?
Dialysis is indicated in severe metabolic acidosis, hyperkalaemia refractory to treatment, intoxication (e.g., aspirin, lithium) refractory to supportive treatment, pulmonary oedema or severe hypertension due to volume overload, uraemic encephalopathy.
What is the prognosis for AKI in childhood?
AKI in childhood generally has a good prognosis unless it is complicating a more serious condition (e.g., severe infection, following cardiac surgery).
