SIM session 4 Flashcards
Risk factors for development of AKI
Risk factors for AKI include:
- chronic kidney disease
- other organ failure/chronic disease e.g. heart failure, liver disease, diabetes mellitus
- history of AKI
- use of drugs with nephrotoxic potential (e.g. NSAIDs, aminoglycosides, ACE inhibitors, angiotensin II receptor antagonists [ARBs] and diuretics) within the past week
- use of iodinated contrast agents within the past week
- age 65 years or over
- neurological or cognitive impairment or disability, which may mean limited access to fluids because of reliance on a carer
What urine output is considered as AKI?
oliguria (urine output less than 0.5 ml/kg/hour)
What happens in AKI / when kidneys stop working?
- oliguria = urine output of less than 0.5 ml/kg/hour
- fluid overload
- a rise in molecules that the kidney normal excretes/maintains a careful balance of. Examples include potassium, urea and creatinine
Signs and symptoms of AKI
Many patients with early AKI may experience no symptoms
However, as renal failure progresses the following may be seen:
- reduced urine output
- pulmonary and peripheral oedema
- arrhythmias (secondary to changes in potassium and acid-base balance)
- features of uraemia (for example, pericarditis or encephalopathy)
Criteria for AKI detection
Any of the following criteria:
- a rise in serum creatinine of 26 micromol/litre or greater within 48 hours
- a 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days
- a fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults
Management of AKI
- largely supportive
- careful fluid balance (properly perfused but avoid fluid overload)
- review a patient’s medication list
- Hyperkalaemia -> prompt treatment to avoid arrhythmias
- nephrologist input -> if the cause is not known or where the AKI is severe
- urologist input -> if AKI suspected secondary to urinary obstruction require
- renal replacement therapy -> when a patient is not responding to medical treatment of complications, for example hyperkalaemia, acidosis or uraemia.
Medications that are usually safe to continue in AKI
- Paracetamol
- Warfarin
- Statins
- Aspirin (at a cardioprotective dose of 75mg od)
- Clopidogrel
- Beta-blockers
Medications that should be stopped in AKI - they do worsen kidney function
- NSAIDs
- Aminoglycosides
- ACE inhibitors
- Angiotensin II receptor antagonists
- Diuretics
Medications that need to be stopped in AKI because renal increases risk of drug toxicity
- Metformin
- Lithium
- Digoxin
Treatment of hyperkalaemia (3)
- Intravenous calcium gluconate -> to stabilise cardiac membrane
- Combined insulin/dextrose infusion & Nebulised salbutamol -> to induce short-term shift of potassium from extracellular to intracellular fluid
- Calcium resonium (oral or enema), loop diuretics, dialysis -> to remove potassium from the body
1st line treatment for hypertension according to NICE guidelines
Depends on age: either ACE-inhibitor or CCB
What’s AKI stage 1? (3)
AKI stage 1
- rise of >/= 1.5 x baseline creatinine level -> which is known or presumed to have occurred within prior 7 days
- OR >26 micromol/L within 48 hours
- OR urine output <0.5 ml/kg/h for 6-12 h
What’s AKI stage 2?
AKI stage 2
- rise of >/= 2 x baseline creatinine levels
- OR urine output < 0.5 mL/kg/hr for >/= 12 hours
Questions to be asked in pt presenting with diarrhoea
- how long for
- how often during the day
- colour/blood
- change to diet
- travel
- weight loss
What are common causes of diarrhoea in an adult?
- norovirus/rotavirus
- campylobacter
