AKI Flashcards
Define AKI
an abrupt (<48 hours) reduction in kidney function -
- an absolute increase in creatinine by more than 26.4
- a risk of creatinine more than 50 percent
- a reduction in urine output to less than 0.5ml/kg/hour for more than 6 hours
risk factors for AKI
age diabetes CKD cardiac disease liver disease PVD previous AKI urological obstruction
precipitating factors for AKI
hypotension hypovolaemia sepsis contrast medications - gentamicin, NSAIDs dehydration surgery trauma burns
give pre renal causes of AKI
dehydration hypovolaemia haemorrhage burns cardiogenic shock sepsis analphylaxis NSAID/ARB/ACE hepatorenal syndrome
give renal causes of AKI
glomerulonephridites vasculitis interstitial nephritis tubular injury - gentamycin, rhabdomyolysis, contrast, ischaemia cholesterol embolism
give post renal cause of AKI
obstruction stones cancer stricture extrinsic compression
what medications should be stopped in AKI
NSAIDs
ARB or ACE
nephrotoxics e.g. gentamycin
what is acute tubular necrosis
results due to tubular ischaemia as a result of PRE RENAL AKI
treatment of pre renal aki
treat cause
in general REHYDRATION is mainstay
signs and symptoms of renal aki
anorexia, weight loss fatgiue n and v itch - due to uraemia fluid overload SOB - due to effusion or pulmonary oedema
what happens to UE in AKI
initally K will be reduced followed by increased K as renal elimation is reduced
Na and chlorine reduce
complications of AKI are
hyperkalaemia fluid overload severe acidosis uraemic pericardial effusion severe uraemia more than 40
post renal AKI treatment
catheter or nephrostomy stent maintainance fluids CTKUB avoid NSAID for pain relief - use tamsulosin
ecg changes in hyperkalaemia
peaked t wave ‘tented’
flat p wave
sine wave
treatment of hyperkalaemia
10mls of 10 percent calcium gluconate
Insulin and dextrose (10 units actarapid and 5 percent dextrose)
or salbutamol neb for 90 mins
