Renal - Acute Kidney Injury Flashcards
Name 5 risk factors that predispose patients to AKI
ELDERLY
SEPSIS
DIABETES
CKD
IATROGENIC - Ace inhibitors, NSAID’s, antibiotics, angiotensin receptor inhibitors.
IHD
What are the stages of AKI?
STAGE 1 - Serum creatinine 1.5-1.9x greater than baseline
STAGE 2 - Serum creatinine 2-2.9x greater than baseline
STAGE 3 - 3 times greater than baseline
What causes pre-renal AKI?
Hypovolaemia
Impaired renal auto regulation - NSAIDs, ACE inhibitors and nephrotoxic drugs such as cyclosporine.
What causes intrinsic AKI?
Glomerular pathology - acute glomerulonephritis
Tubules and interstitial pathology - eg. Ischaemia, sepsis/infection or nephrotoxins
Vascular - vasculitis, malignant hypertension
What causes post-renal AKI?
Bladder outlet obstruction
Bilateral pelvo-ureteric obstruction
What investigations would you want to carry out in AKI?
- Urine dipstick
- U+E’s, LFT’s, bone profile, CRP
- CK - rhabdomyolysis is suspected
- c-ANCA, p-ANCA - looking for vasculitis
- Anti-GBM
- ANA
- C3, C4 - looking for lupus nephritis
- Serum immunoglobulins and electrophoresis - query myeloma
- Post streptococcal infection? Do an anti-Streptolysin O titre
- If you are suspecting DIC carry out a haemolysis screen which includes an FBC, LDH, blood film, bilirubin, reticulocytes.
- Cryoglobulins
How do you manage AKI?
- Send off investigations to find underlying cause
- Discontinue nephrotoxic agents if possible
- Assess and manage volume status
- Avoid hyperglycaemia
- Refer to specialist to consider renal replacement therapy
Name some indications for renal replacement therapy (RRT)
- Hyperkalaemia as a result of medical therapy
- Metabolic acidosis as a result of medical therapy
- Fluid overload non responsive to diuretics
- Uraemic pericarditis
- Uraemic encephalopathy - vomiting, confusion, drowsiness, reduced consciousness
- intoxications
