Acute Kidney Injury

Question 1

How do you diagnose AKI

Answer 1

Increase in Serum Cr of >26.5 within 48 hours

OR

1.5x from baseline (known or presumed to have occured within past 7 days)

OR

Decrease in urine output <0.5ml/kg/hr over last 6 hours (make sure no obstruction first)

Question 2

What are some common pre-renal causes of AKI

Answer 2

1. Hypotension
2. Hypovolemia
3. Renal artery disease
4. Cardio-renal syndrome
5. Hepato-renal syndrome

Question 3

What are some intrinsic causes of AKI

Answer 3

1. ATN (may be due to ischemia, sepsis or drug toxins)
2. Acute interstitial nephritis
3. Glomerulonephritis
4. Microvascular disease

Question 4

What are some post-renal causes of AKI

Answer 4

1. Bladder outlet obstruction (eg BPH, cancer, neurogenic bladder)
2. ureteric obstruction

Question 5

What are some of the most required investigation in AKI

Answer 5

1. FBC, coagulation screen (for anemia, thrombocytopenia)
2. RP with UECr
3. BUN
4. UFEME
5. US KUB

Question 6

How can you differentiate pre-renal AKI with ATN

Answer 6

Using UFEME, ATN has brown casts. Pre-renal and post renal usually will be normal or have WBC with hyaline casts

Question 7

What are some common complications of AKI

Answer 7

1. Hyperkalemia
2. Metabolic acidosis
3. Acute pulmonary edema
4. Uremic encephalopathy/ pericarditis

Question 8

When do you consider dialysis

Answer 8

1. Acidosis
2. Electrolytes
3. Intoxication
4. Overload states
5. Uremia

Question 9

What are the medications to avoid in AKI

Answer 9

Sulfonyureas
Ace inhibitors
Diuretics
Metformin
ARBs
NSAIDs
SGLT2 inhibitors

Question 10

How do you manage hyperkalemia

Answer 10

Depending on severity
1. 40ml 50% Dextrose with 10 unit of insulin
2. Salbutamol 10-20mg nebulised
3. IV calcium gluconate 10% 30ml

Question 11

What is the medication used for acidosis

Answer 11

Sodium bicarbonate

Question 12

What is the management for pulmonary edema

Answer 12

IV GTN and furosemide