Renal: AKI Flashcards
What is the most common cause of AKI in children?
- haemolytic uraemic syndrome (HUS)
Haemolytic Uraemic Syndrome (HUS) is a triad of:
- Microangiopathic haemolytic anaemia (Coombs’ test negative).
- Thrombocytopenia.
- Acute kidney injury (acute renal failure).
glomeruli become clogged with platelets and damaged red blood cells.
What causes HUS? What is the classical presenting feature?
- 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 should suspected HUS be investigated?
- 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 is HUS managed?
- notify local health protection team
- supportive treatment - fluid and electrolyte management, dialysis if needed
- > 80% make full recovery
What is AKI?
- 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).
What are the causes of AKI? Pre, renal, post?
What are the diagnostic criteria for AKI?
- 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 is AKI staged?
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
When should I arrange urgent admission (same day) for AKI?
- 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 should AKI be managed in primary care if patient not requiring hospital admission, referral or specialist input?
- 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