Week 2 - Acute Kidney Injury (AKI)

Question 1

What is AKI

Answer 1

Sudden episode of kidney failure / kidney damage
- occurs within a few hours / days

Causes failure to
- maintain fluid balance
- maintain electrolyte level
- acid-base imbalance

30% of AKI can be prevented

Question 2

What causes AKI

Answer 2

1. Pre-renal
   - 80% of AKI cases
   - CAUSE: inadequate perfusion - i.e. not enough blood flowing at sufficient pressure for filtering to occur / prolonged fall in BP
   What can cause BP drop:
   - vol. depletion
   - ↓ CO due to HF, MI, ischemia = ↓ BP
   - medication which ↓ BP
   - obstruction of renal arteries
2. Renal
   - 10% of AKI cases
   - CAUSE: structural damage to kidneys (due to medicine + sustained drop in BP)
3. Post-renal
   - 10% of AKI cases
   - obstruction to urinary flow (in renal tract)
   - caused by; renal stones, tumours, blocked catheter

Question 3

What are patient risk factors for AKI

Answer 3

• Have underlying CKD
• History of AKI
• Cancer
• Old age (>65)
• Co-morbidities - HF, diabetes
• Dehydration
• Reduced urinrary flow
• Sepsis

Question 4

List the renal function tests + symptoms

Answer 4

• Reduce urine output
  - <0.5ml/kg/hr for > 6 hrs)
• Urinalysis (change in urine colour - i.e. dark urine)
• Estimated GFR
• Serum creatinine
  - compare measured value to baseline value
  (don’t always have basle = problem)
  - diagnosed if ↑ of 26 micromol/L within 48hrs
  - 50% ↑ within past 7 days

After diagnosis, determine stage (there are 3 stages of AKI)
- stage 3 = most severe

Can be asymptomatic
Symptoms:
- feeling thirsty
- nausea
- tiredness
- confusion

Question 5

How is AKI managed

Answer 5

NO specific treatment for AKI

• Early identification
  - treat potential causes
• Review medication
• Managing any modifiable risk factors
• Monitor BP, electrolyte levels, hydration status, urine output

Question 6

How can medicines be used safely in people with AKI

Answer 6

• Making dose adjustments (in line with their impairment)
• Ensure not nephrotoxic

Question 7

List the common drug causes of AKI

Answer 7

• ACEi
• ARBs
• CCBs
• B-blockers
• NSAIDs
• Diuretics
• Immunosuppressants
• Hypoglycemics
• Antibiotics

Question 8

How can pharmacist prevent and manage AKI

Answer 8

Do a thorough MEDICATION REVEIW
- identify if any medication may be causing AKI
- avoid inappropriate combinations of medicine
- ensure all medication is clinically appropriate
- ensure medicine has been dose adjusted (for impairment)
- ensure blood levels are monitored where required
- reduce occurrence of adverse effects

Question 9

List drug-condition interactions relevant to GI, liver and kidney

Question 10

What is sick day guidance

Answer 10

Info given to patients by healthcare professional about how to manage their own medication if they become unwell
- may be advised to withhold taking a certain medication if have fever, diarrhoea etc,

HOWEVER this can cause more harm than good
- patients may stop taking medication when not necessary
- can reduce adherence
- may make condition worse e.g. stop taking anti-hypertensive may get MI