Nephrology - AKI Flashcards
Definition of Acute Kidney Injury
Abrupt loss of kidney function, resulting in the retention of urea and other nitrogenous waste products and in the dysregulation of extracellular volume and electrolytes.
Clinical features of acute kidney injury
- Anuria/oliguria (<0.5ml/kg/hr)
- Hypertension with fluid overload
- Rapid rise in plasma creatinine
Resuts indicating AKI
- Serum creatinine > 1.5x age specific reference creatinine (or previous baseline if known)
- Urine output <0.5 ml/kg for > 8hours
Interpretation of AKI warning score
- AKI 1: Measured creatinine >1.5-2x reference creatinine/ULRI
- AKI 2: Measured creatinine 2-3x reference creatinine/ULRI
- AKI 3: Serum creatinine >3x reference creatinine/ULRI
AKI management
3 Ms
- Monitor
- Urine Output, PEWS (paediatric early warning score, BP, weight
- Maintain
- good hydration
- Minimise
- drugs
Pre-renal causes of acute kidney injury
Perfusion problem
- Volume depletion
- Oedematous states
- Hypotension
- Renal hypoperfusion
- Drugs
- Renal artery stenosis or occlusion
- Hepato-renal syndrome.
Intrinsic causes of acute kidney injury
- Glomerular disease
- HUS
- Glomerulonephritis
- Tubular injury
- Acute tubular necrosis (ATN)
- Consequence of hypoperfusion
- Drugs
- Interstitial nephritis
- NSAID
- Autoimmune
Post renal causes of AKI
Acute obstruction of urinary flow
Causes of Haemolytic-Uraemic Syndrome
- Post diarrhoea
- Entero-Haemorrhagic E.coli (EHEC)
- Verotoxin producing E.coli – VTEC
- or Shiga toxin (STEC)
- Entero-Haemorrhagic E.coli (EHEC)
- Other causes
- pneumococcal infection, drugs
What can cause atypical HUS
- Autoimmune process
- Can be congenital or acquired
What seerotype of E.coli is responsible for HUS
E coli O157:H7
What is the period of risk of HUS with E coli O157 infection?
- Up to 14 days after onset of diarrhoea
- 15% develop HUS
What organs are vulnerable in shiga toxin dissemination?
- Kidneys
- Adrenals
- Heart
- Lungs
- Brain
- Pancreas
What is the triad of Haemolytic-Uraemic Syndrome?
- Microangiopathic haemolytic anaemia
- Thrombocytopenia
- AKI
Managenent of Haemolytic-Uraemic Syndrome
3Ms
- Monitor (5 kidney functions)
- Fluid balance, electrolytes, acidosis
- Hypertension
- Aware of other organs
- Maintain
- IV normal saline and fluid
- Renal replacement therapy
- Minimise
- No antibiotics
