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TCA 13 - AKI > Investigations and management > Flashcards

Investigations and management Flashcards

1
Q

What investigations should you do for AKI?

A
  • Serum creatinine
  • Urinalysis
  • Urine culture (MSSU)
  • Stool culture
  • Bloods
  • CXR
  • Renal USS
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2
Q

What would you be looking for on a CXR?

A
  • Pulmonary oedema

- Pneumonia

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3
Q

What does a urinalysis look for?

A
  • Blood
  • Protein
  • Leucocytes
  • Nitrites
  • Glucose
  • Urobilinogen
  • Conjugated Bilirubin
  • pH
  • Specific gravity
  • Ketones
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4
Q

What would blood +ve on urinalysis indicate?

A
  • Trauma
  • Malignancy
  • Stones
  • Rhabdomyolysis
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5
Q

What would blood and protein +ve on urinalysis indicate?

A
  • Glomerulonephritis
  • Vasculitis
  • UTI
  • Malignant hypertension
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6
Q

What would protein +ve on urinalysis indicate?

A
  • Glomerulonephritis
  • Amyloid
  • Severe HTN
  • Diabetic nephropathy
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7
Q

What would blood and protein -ve on urinalysis indicate?

A
  • Pre- or post-renal
  • Interstitial nephritis
  • Drugs
  • Myeloma (cast nephropathy)
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8
Q

What would ketone +ve on urinalysis indicate?

A
  • Starvation

- DKA

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9
Q

What would glucose +ve on urinalysis indicate?

A
  • Diabetes
  • Tubular defect
  • SGLT-2 inhibitors
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10
Q

What would nitrites or leucocytes +ve on urinalysis indicate?

A
  • UTI

- Foreign body (catheter/stone)

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11
Q

When would you send for a urine culture?

A

If urinalysis shows leucocytes or nitrites

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12
Q

When would you get a renal USS?

A
  • Only if there is no other identifiable cause or patient is at rx of urinary tract obstruction
  • Look for obstructed kidneys (hydronephrosis), kidney size
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13
Q

What bloods would you order?

A
  • U+Es
  • Autoimmune screen (ANCA, ANA, dsDNA, anti-GBM, RhF, C3, C4) if glomerulonephritis or vasculitis suspected
  • Immunoglobulins, serum EP and urine for Bence Jones protein -> even if myeloma not suspected
  • ABG if EWS ≥3
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14
Q

When would you urgently refer a patient for a same-day referral?

A 
•	Stage 3 AKI
•	Kidney/UT obstruction
•	No identifiable cause
•	Sepsis
•	Evidence of hypovolaemia	
•	Deterioration in clinical condition
•	Complication of AKI:
       Pulmonary oedema
       Uraemic encephalopathy
       Pericarditis
       Severe hyperkalaemia
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15
Q

When would you discuss management with a nephrologist?

A 
•	CKD 4 or 5
•	Specialist management:
       Tubulointerstitial nephritis
       Glomerulonephritis (proteinuria and haematuria)
       Systemic vasculitis
       Myeloma 
•	Inadequate response to treatment
•	Renal transplant
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16
Q

How would you manage stage 1 AKI?

A
  • Manage the cause
  • Supportive maintenance of hydration
  • Stop nephrotoxic medications or adjust medication in relation to renal function
17
Q

What medications need to be stopped in AKI as they may worsen renal function?

A
  • NSAIDs
  • Aminoglycosides
  • ACE-i
  • ARBs
  • Diuretics
18
Q

What medications need to be stopped in AKI due to increased risk of toxicity?

A
  • Metformin
  • Lithium
  • Digoxin
19
Q

How would you treat fluid overload or oedema associated with AKI?

A

Furosemide

20
Q

When is dialysis used?

A

AEIOU

A - Acidosis (pH <7.35)
E - Electrolyte imbalance (hyperkalaemia)
I - Intoxications
O - Overloaded with fluid (pulmonary oedema)
U - Uraemic encephalopathy or uraemic pericarditis

21
Q

What is normal serum potassium?

A

3.5-5 mmol/L

22
Q

How would you investigate abnormal potassium?

A
  • Renal function
  • ABGs
  • ECG
23
Q

What are the ECG changes of hyperkalaemia?

A
  • Peaked T-waves
  • Small or indiscernible P-waves
  • Broad QRS (>3 small squares)
  • QRS slurring into ST-segment
24
Q

How would you treat hyperkalaemia?

A
  1. Stabilise myocardium if there are conduction abnormalities or arrhythmias
    Calcium gluconate
  2. Short-term shift in potassium back into cells
    Insulin/dextrose infusion (monitor BG)
    Salbutamol
  3. Removal of potassium from the body
    Calcium resonium
    Loop diuretics
    Dialysis
25
Q

How do you manage hypokalaemia?

A
  • Correct any underlying electrolyte abnormalities such as hypomagnesaemia
  • Potassium chloride in sodium chloride

TCA 13 - AKI (5 decks)

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