Lecture 17 Acute Kidney Injury Flashcards
What is the serum creatinine and urine output in stage 1 AKI
1.5-1.9 times baseline
<0.5 ml/kg/h for 6-12 hours
What is the serum creatinine and urine output in stage 2 AKI
2.0–2.9 times baseline
<0.5 ml/kg/h for ≥12 hours
What is the serum creatinine and urine output in stage 3 AKI
3.0 times baseline
OR Increase to ≥354 μmol/l (and above)
OR Initiation of renal replacement therapy
<0.3 ml/kg/h for ≥ 24 hours OR Anuria for ≥12 hours
What are the immediate dangerous complications of AKI
Acidosis Electrolyte imbalance Intoxication Overload Uraemic complication
At what level of creatinine is it too late to act
When creatinine reaches 400
Name the pre-renal causes of AKI
- Cardiac failure
- Haemorrhage
- Sepsis
- Vomiting & Diarrhoea
What are the intrinsic causes of AKI
- Glomerulonepritis
- Vasculitis
- Radiocontrast
- Myeloma- type of cancer that develops from cells in the bone marrow
- Rhabdomyolysis- breakdown of damaged skeletal muscle
- Drugs (NSAIDs, Gentamicin)
What are the post renal causes of AkI
Tumours
Prostate disease
Stones
Name AKI risk events
- Sepsis (pneumonia, cellulitis, UTI)
- Toxins (X-ray contrast, NSAIDs, gentamicin, Herbal remedies)
- Hypotension
- Hypovolaemia
- Major surgery
Name AKI risk factors
- Age>75
- Previous AKI
- Heart failure
- Liver disease
- Chronic kidney disease
- DM
- Vascular disease
- Cognitive impairment
What protocol should be activated if AKI is suspected
- Sepsis- if suspected screen and treat promptly
- Toxins- avoid (Gentamicin, NSAIDs, IV iodinated contrast)
- Optimise BP and volume status- avoid/correct hypovolaemia, review BP medications
- Prevent harm- daily U&Es, fluid balance and medication review
What is the medicine sick day rule
- If unwell with vomiting or diarrhoea/ fever, sweats and shaking
- Stop taking medicine and restart when well (24-48 hours of eating and drinking normally)
What us an AKI alert
The AKI detection algorithm will produce a test result for every creatinine result that is consistent with AKI; the test result is named ‘AKI Warning Stage
How do you respond to AKI
Assess volume status Suspect Sepsis Hypovolaemia Obstruction Urinanalysis Toxins- stopping certain drugs that maybe be harmful with reduced kidney function
Indications for renal referral
Persistent oliguria Resistant Hyperkalaemia Resistant pulmonary oedema Severe metabolic acidosis Suspicion of intrinsic disease Low platelets- haemolytic, uraemia syndrome Stage 3
What investigations and assessments should be done if AKI is suspected
• History • Examination – Fluid status etc • Drugs • Insults • Renal function etc • Urine dipstick • FBC • USS • Blood gas • Further blood tests for specifics if indicated
What tests should be done if AKI is suspected
Blood- U&Es, LFT, one, FBC, clotting, Blood gas ANCA, Ig, CS C4 dsDNA Urine- dipstick (blood/protein), PCR/AVR Histology- renal bx Radiology- Ultrasound
What are the steps involved in reviewing someone with AKI
Bloods- daily (bicarbonate/hyperkalaemia)
Ultrasound
Medication- appropriate adjustment of drugs
Plan- review fluid balance, daily weights
Name potential indications for a follow up for someone with AKI
Acidosis Electrolyte imbalance Intoxication Overload Uraemic compliactions
How would you carry out a follow up for someone with AkI
Record- document events of AKI
Repeat bloods to see if they have returned to normal
Treatment and medication review
What ECG changes would you see in an AKI patient with hyperkalaemia
Elevated T wave
Depressed and flattened P wave
Widened QRS complexed
Depressed ST segment
How would you treat hyperkalaemia
Stabilise (myocardium) – Calcium Gluconate Shift (K+ intracellularly) – Salbutamol – Insulin-Dextrose Remove – Diuresis – Dialysis – Anion exchange resins
