Renal: AKI Flashcards

1
Q

What is the most common cause of AKI in children?

A
  • haemolytic uraemic syndrome (HUS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Haemolytic Uraemic Syndrome (HUS) is a triad of:

A
  1. Microangiopathic haemolytic anaemia (Coombs’ test negative).
  2. Thrombocytopenia.
  3. Acute kidney injury (acute renal failure).

glomeruli become clogged with platelets and damaged red blood cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What causes HUS? What is the classical presenting feature?

A
  • Shiga toxin-producing E. coli (STEC)
  • can occur after contact with cattle/farm animals, not cooking minced beef well.
  • profuse diarrhoea that turns bloody 1-3 days later.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How should suspected HUS be investigated?

A
  • FBC and film (raised WCC and low platelets), fragmented red cells on film, low Hb
  • U&E - rise in urea and creatinine
  • LDH - high LDH early indicator
  • Clotting screen
  • Stool sample
  • Urinalysis: haematuria or proteinura are early signs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is HUS managed?

A
  • notify local health protection team
  • supportive treatment - fluid and electrolyte management, dialysis if needed
  • > 80% make full recovery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is AKI?

A
  • an abrupt decrease in kidney function occurring over 7 days or fewer.
  • diagnosis of AKI and its staging is based on acute changes in serum creatinine and/or a reduction in urine output (oliguria).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the causes of AKI? Pre, renal, post?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the diagnostic criteria for AKI?

A
  • Any of the below criteria:
  • rise in serum creatinine >=26 micromol/L within 48hrs
  • 50% rise in serum creatinine within last 7 days
  • fall in urine output to <0.5ml/kg/hr for more than 6 hours.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is AKI staged?

A

AKI 1: Cr 1.5x baseline level or rise of 26 micromol/L <48hrs.

AKI 2: Cr 2x baseline level

AKI 3: Cr 3x baseline level or Cr >354 micromol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When should I arrange urgent admission (same day) for AKI?

A
  • AKI 3
  • underlying cause requiring urgent management e.g. urinary tract obstruction, upper UTI
  • no clear cause for AKI
  • At risk of urinary tract obstruction
  • Sepsis
  • Hypovolaemia - needing IV fluids and monitoring
  • deterioration in clinical condition - need for more frequent monitoring
  • suspected complication of AKI - pulmonary oedema, uraemic encephalopathy, pericariditis, severe hyperkalaemia (>=6.5)

Liaise with nephrologist if:
CKD 4/5
? glomerulonephritis, vasculitis, myeloma
hx renal transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How should AKI be managed in primary care if patient not requiring hospital admission, referral or specialist input?

A
  • manage underlying cause
  • urine dip - protein and blood, UTI
  • advise on fluid intake
  • stop nephrotoxic meds until improved
  • regularly monitor U&E
  • refer if deteriorate/ not responding
  • monitor for 3 years after AKI to check for progression to CKD (even if egfr returns to baseline)
  • review meds - check U&E 1-2 weeks after restarting any med
How well did you know this?
1
Not at all
2
3
4
5
Perfectly