RRAPID: Acute Kidney Injury (AKI)

Question 1

Definitions of AKI? (3)

Answer 1

Serum creatinine > 26 umol/L within 48 hrs

Serum creatinine 1.5 x baseline value within 1 week

Urine output < 0.5 ml/kg/hr for 6 hrs

Question 2

Definition of Stage 1 AKI? (3)

Answer 2

Serum creatinine > 26 umol/L within 48 hrs

Rise in serum creatinine 1.5-1.9 x baseline value

Urine output < 0.5 ml/kg/hr for 6 hrs

Question 3

Definition of Stage 2 AKI? (2)

Answer 3

Rise in serum creatinine 2.0-2.9 x baseline value

Urine output < 0.5 ml/kg/hr for 12 hrs

Question 4

Definition of Stage 3 AKI? (4)

Answer 4

Serum creatinine > 354 umol/L

Rise in serum creatinine 3.0 x baseline value

Urine output less than <0.3 ml/kg/hr for 24 hrs OR ANURIC FOR 12 HRS

Commenced renal replacement therapy

Question 5

Pre-renal causes? (4)

Answer 5

Dehydration (vomiting, burns, diarrhoea, haemorrhage)
Hypotension
Sepsis
Cardiac failure

Question 6

Intrinsic renal causes? (5)

Answer 6

Prolonged hypo-perfusion
Nephrotoxins
Glomerulonephritis 
Vasculitis 
Interstitial nephritis

Question 7

Post-renal causes? (5)

Answer 7

Obstruction:
Renal stones
Fibrosis 
Bladder cancer
Pelvic mass
Enlarged prostate

Question 8

Signs/Symptoms? (7)

Answer 8

Hypovolaemia
Palpable bladder?
Signs of vasculitis? (weight loss, fever, rash, uveitis, haemoptysis, joint swelling) 
Haematuria 
N&V
Confusion/coma
BRUITS - renal artery stenosis?

Question 9

Investigations? (5)

Answer 9

Bloods: FBC, U&E's, LFT's, bicarbonate, calcium, phosphate
Blood cultures (if suspected sepsis)
Urine dipstick
CXR - cardiac failure
Renal US - obstruction

Question 10

Complications of AKI? (4)

Initial Response?

Answer 10

Hyperkalaemia (built up of electrolytes)
Pulmonary oedema (built up fluid, urea, creatine etc)
Acidosis
Pericarditis

ABCDE

Question 11

Response (Circulation)? (3)

How would you treat fluid overload? (3)

Answer 11

IV access: bloods & fluids
Treat underlying cause
Treat complications

O2, nitrates, furosemide

Question 12

Response (E)?

Answer 12

Review drug chart for dosage adjustment and nephrotoxins

Question 13

Nephrotoxic drugs?

Answer 13

DAAAMN: diuretics, ACE-i, ARB’s, Aminoglycosides, Metformin, NSAIDS.

Question 14

Indications of renal replacement therapy? (5)

Answer 14

UFAKE:

U - Uraemic pericarditis /encephalopathy
F - Fluid overload
A - acidosis (pH)
K - K+ (hyperakalaemia)
E - Extras (toxins, temperature)