Acute Kidney Injury

Question 1

Definition and causes of AKI

Answer 1

Low urine output:

Stage 1: <0.5ml/kg per h/6h
Stage 2: <0.5ml/kg per hx 12h
Stage 3: <0.3 ml/kg per h x24hr, anuria / 12hrs

Creatinine:

Stage 1: X 1.5
Stage 2: X 2
Stage 3: X3

Question 2

Airway

Answer 2

Question 3

Breathing

Answer 3

Look - respiratory distress (tachypnoea, cough)
Listen –fine crackles, signs of pulmonary oedema
Feel chest expansion

1. RR, O2 sats, if low à 15L O2 NRB
2. ABG if hypoxic and can look at electrolytes
3. CXR

Question 4

Circulation

Answer 4

Look for signs of fluid overload

Listen

Feel

Investigations

1. HR, BP
2. IV access
3. bloods – FBC, LFTs, U&Es, CRP, antibody screen, VBG for electrolytes and lactate for sepsis. Consider blood cultures

Management:

1. correct any shock IV fluid bolus if hypovolaemic (pre-renal)
2. hyperkalaemoa
3. pulmonary oedema

Question 5

Disability

Answer 5

GCS - confusion uraemia
PEARL
neuro
BM
**Drug chart - nephrotoxic drugs? ** stop offending drug

Question 6

Exposure

Answer 6

Bladder scan (post-renal)
DRE
lines
catheter
urine dip
abdominal exam
calves

Question 7

Important bits for AKI

Answer 7

• Worried about: shock, pulmonary oedema, hyperkalaemia
• Escalate: to renal SpR
• Άμα ο άρρωστος δεν τραβάει - consider HDU and continious cardiac monitoring
• Acute dialysis may be indicated

Question 8

Management of hyperkalaemia

Answer 8

Causes of hypokalaemia:
1. Low K in diet
2. Increased loss in diarhoea and vomiting
3. High output stoma
5. Diuretics (furosemide)
6. Renal loss: Cusing’s, Conn’s syndrome
7. Redistribution into cells - insulin, beta agonists, alkalosis
5. RTA type II,I

Causes of hyperkalemia:
1. AKI, CKD
2. Addison’s
3. Drugs (ACEi, ARBs, NSAIDs)
4. DKA, metabolic acidosis, rhabdo
5. Spironolactone

Management:

If > 6.5 or ECG changes then:

1. 10% 10 ml calcium gluconate IV over 2-10 minutes
2. 10 U actrapid in 50 ml + 200ml 10% dextrose over 15-30 minutes
3. Salbutamol nebuliser 5mg stat
4. Oral calcium resonium 15g TDS

Treat CAUSE:
- Hypovolaemia - IV fluids
- Retention - cathetirise
- PO - cautiously furosemide

Indications for dialysis:
Acidosis
Uraemia
Eletrolytes (hyper K)
Intoxication
Oedema