Acute Kidney Injury

Question 1

Acute kidney injury is defined as being an increase in serum creatinine by how much AND urine volume of how much?

Answer 1

Increase in serum creatinine: by ≥ 26.5 μmol/l (0.3 mg/dl ) within 48 hours
or
to ≥ 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days

AND
Urine volume <0.5ml/kg for 6hrs

Question 2

What are some of the immediately dangerous consequences of AKI?

Answer 2

Acidosis
Electrolyte imbalance
Intoxication
Overload
Uraemic complications

AEIOU

Question 3

For AKI Stage 1, what is the serum creatinine level?

Answer 3

1.5-1.9 x the baseline

Question 4

For AKI Stage 1, what is the urine output?

Answer 4

<0.5ml/kg/h for 6-12hrs

Question 5

For AKI Stage 2, what is the serum creatinine level?

Answer 5

2-2.0 x the baseline

Question 6

For AKI Stage 2, what is the urine output?

Answer 6

<0.5ml/lg/h for >12hrs

Question 7

For AKI Stage 3, what is the serum creatinine level?

Answer 7

3 x the baseline

Question 8

What are some of the pre-renal causes of AKI?

Answer 8

Cardiac failure
Haemorrhage
Sepsis
Vomiting and diarrhoea

Question 9

What are some of the intrinsic causes of AKI?

Answer 9

Glomerulonephritis
Vasculitis
Radiocontrast
Myeloma
Rhabdomyolysis
Drugs e.g. NSAIDs, gentamicin

Question 10

What are some post-renal (obstruction) cause of AKI?

Answer 10

Tumours
Prostate disease
Stones

Question 11

What are some risk factors for AKI?

Answer 11

Age >75
Previous AKI
Heart failure
Liver disease
CKD
Diabetes
Vascular disease
Cognitive impairment

Question 12

What are some risk events for AKI?

Answer 12

Sepsis
Toxins
Hypotension
Hypovolaemia
Major surgery

Question 13

List some toxins which should be avoided if a patient is at risk of AKI.

Answer 13

Gentamicin
NSAIDs
IV iodinated contrast

Question 14

There are some medications which should not be taken if someone has vomiting or diarrhoea, fevers, sweats and shaking.
They can be restarted when the individual is well.
Give some examples of these medicines.

Answer 14

ACEi
ARBs
NSAIDs
Diuretics
Metformin

Question 15

Give some examples of ACEi

Answer 15

Ramipril, lisinopril

Question 16

Give some examples of ARBs

Answer 16

Candesartan, valsartan

Question 17

Give some examples of NSAIDs

Answer 17

Ibuprofen, naproxen

Question 18

Give some examples of diuretics

Answer 18

Furosemide
Spironolcatone

Question 19

RECAP- what is metformin used in the treatment of?

Answer 19

Diabetes

Question 20

Assessing volume status in a patient with AKI is essential.
If a patient is hypovolaemic, what should be done?

Answer 20

Give boluses of fluid as per IV perscription guidelines
Then treat as per euvolaemia*

*normal amount of fluids in the body

Question 21

Assessing volume status in a patient with AKI is essential.
If a patient is euvolemic, what should be done?

Answer 21

Give only maintenance fluid

Question 22

The response to AKI can be remembered using the acronym SHOUT.
Run through this please!

Answer 22

Suspect sepsis

Hypovolaemia

Obstruction- consider bladder scan and/or ultrasound

Urinalysis

Toxins

Question 23

What kind of investigations are carried out in someone with suspected AKI?

Answer 23

Renal function test
Urine dipstick
FBC
USS
Blood gas

More specific blood tests if required

Question 24

What blood tests would routinely get done for someone with suspected AKI?

Answer 24

U&Es
Bicarb
LFT’s
FBC
Clotting

Question 25

What we be looked at in urinalysis using a urine dipstick for someone with suspected AKI?

Answer 25

Blood? Protein?

Question 26

Using the acronym BUMP, what gets covered/considered in an AKI review?

Answer 26

Bloods Ultrasound? Medicines - to ensure appropriate dose adjustments Plan for fluid maintenance

Question 27

What should be done in an AKI follow-up?

Answer 27

Repeat bloods to ensure back to normal Treatment and medicine review

Question 28

What changes would be seen in an ECG if a patient had hyperkalaemia?

Answer 28

Peaked T waves P wave widens and flattens PR segment lengthens P waves eventually disappear Prolonged QRS interval Arrhythmias ->Tall T waves are usually one of the earliest signs of hyperkalaemia

Question 29

Describe the treatment for hyperkalaemia. ->apparently one of the most important slides for our future careers uh oh

Answer 29

Firstly, stabilise the heart and myocardium by giving calcium gluconate. This is essential but doesn't do anything to potassium levels so potassium needs to be shifted intracellularly. This can be done by using a salbutamol nebuliser or giving an insulin-dextrose infusion. Then remove the excess potassium using diuresis, dialysis or potassium binders ->wordy but please just try and read through and get the basics