Acute Kidney injury Flashcards
Definition of Acute kidney injury
Increase in Serum Creatinine:
by ≥ 26.5 μmol/l (0.3 mg/dl ) within 48 hours
or by over 50% in last 7 days
or a Urine Creatinine volume <0.5 ml/kg/h for 6 hours
How many stages of acute kidney injury are there?
3
What are some immediately dangerous consequences of AKI
Acidosis Electrolyte imbalance Intoxication - TOXINS Overload Uraemic complications
Think vowels
Short term outcomes of AKI
Hospitalisation
Possible death, dialysis
Intermediate/long-term outcomes of AKI
Death (common)
Chronic KD
Dialysis
CKD related CV events etc
Your risk of renal progression (decline) over 10 years is increased by how much with AKI?
Two-fold
At what level of creatinine is it too late?
400 umol/L
Causes of AKI
Pre-renal:
- Cardiac failure
- Haemorrhage
- Sepsis
- Vomiting + diarrhoea
Post-renal:
- Tumour
- Prostate disease
- Stones
Intrinsic:
- Glomerulonephritis
- Vasculitis
- Radiocontrast
- Myeloma
- Rhabdomyolysis - muscle injury - breakdown of muscle
- Drugs - NSAIDs, Gentamicin
What is better than treatment of AKI
Prevention
Risk factors of AKI
Age >75 Previous AKI Heart failure Liver disease Chronic kidney disease DM Vascular disease Cognitive impairment
In what events are you more at risk of AKI
Sepsis - pneumonia, cellulitis, UTI Toxins Hypotension Hypovolaemia Major surgery
STOP AKI prevention care bundle
S - sepsis - screen + treat
T - toxins - avoid (gentamicin, NSAIDs, IV iodinated contrast) - cause nephrotoxictiy
O - Optimise BP and volume status
P - prevent harm - daily U+E’s, fluid balance and medication review
Investigations for AKI
Renal function (ACR (Albumin to Creatinine Ratio) and GFR (glomerular filtration rate))
Urine dipstick
FBC
USS
Blood gas
Fancy blood tests for specifics if indicated
Examination for AKI
Vital signs (BP, pulse etc.,)
Volume status
Systemic illness (rash, joints, eyes etc.,)
Obstruction
Investigations and assessment AKI
Blood tests - U+E’s, Bicarb, LFTs, bone, FBC, clotting
Urine tests
Radiology
Renal biopsy
