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Medicine Phase 2a GU > Acute Kidney Injury > Flashcards

Flashcards in Acute Kidney Injury Deck (28):
1

Diagnosis of AKI

Rise in Creatinine > 26 micromol/L in 48 hrs (above baseline)
Rise in Creatinine > 50% ( best figure in last 6 months ) within 7 days
Urine output < 0.5ml/kg/hr for > 6 consecutive hours

Need only one of these criteria

2

Which one has got AKI:
1) 23 F , baseline Cr-60 , presented with Cr-100, normal UO
2) 30M, 70kg, baseline Cr-100, admitted with Cr-120 , UO 50ml/hr
3) 80 F, 50kg, a/w long lie on the floor , baseline Cr-200, now Cr-250, UO-30ml/hr
4) 20M, involved in car accident , injury to abdomen , Baseline Cr-60 , now Cr-80 , UO- 10ml/hr for 7hrs

Which is the sickest?

1) Yes
2) No
3) Yes
4) Yes

3 or 4 (abdo damage could mean crushed kidney) is the sickest

3

45F , just had bilateral nephrectomy for RCC , baseline Cr-80 , now Cr-100 , No UO for last 2 hrs .
Has she got AKI ?
Does she need RRT (Renal Replacement Therapy)?
Why?

Yes she has AKI as has no kidneys
RRT is needed

4

Normal creatinine level for male middle aged

50-60

5

Types of causes of AKI

Pre-renal
Renal
Post-renal

6

Pre-renal causes of AKI

(Reduced blood flow to kidney)
Fluid loss from body - diarrhoea and vomiting
Trauma
Burns
Heart failure
Any cause of shock
(Sepsis)

7

Renal causes of AKI

Drugs e.g. steroids (NSAIDs)
Infection/Inflammation of kidney
Trauma
Renal nephritis

8

Post-renal causes of AKI

Kidney stone
Cancer of ureter, bladder or prostate (in men)
Luminal - stone in ureter, blood clot in ureter
Stone in bladder or blood clot in bladder
Prostate enlargement

9

Assessment of patient with AKI

Start with ABCDE (patient is able to talk to you)
History - assess pre-renal, renal, post-renal
Physical examination
Differential diagnosis
Investigations
Initial management

10

As well as bloods, what other investigations can be done?

Urine dip
Ultrasound of kidney, ureter, bladder (blood clot tumour)
Monitoring of urine output

11

Urine dip - what does it show?

Protein

12

True or False:
In initial management of AKI, its always ok to prescribe some IV fluid

Mostly True except in case of heart failure

13

Medical emergency associated with AKI

Hyperkalemia
Failing kidneys wont be able to excrete potassium

14

Other than a blood test, what else could show hyperkalemia

ECG
large T waves and small/indiscernible P waves in V2-6

15

Management of hyperkalemia

First Insulin and Dextrose
Then:
Calcium gluconate (membrane stabiliser of heart)
IV fluid
Salbutamol (B2 agonist)
(calcium resonium - but can cause serious constipation)

16

In management of hyperkalemia, what is action of insulin

Drive potassium from blood stream into cell

17

True or False:
in management of hyperkalemia, calcium gluconate helps reduce potassium levels in blood

False
Has no effect on potassium in the blood
Is a membrane stabiliser of heart

Give to any patient with ECG changes

18

Management of AKI

Stop nephrotoxic drugs
Identification of risk factors
Thinking about common causes
Assessment of the patient with AKI
Investigations
When to refer to a nephrologist
Indications for dialysis

19

What is dialysis

The process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally.

20

Risk factors of AKI

Older Age
Comorbidities
Drugs (e.g. antibiotics)
Reason of admission (e.g. heart failure, vomiting, diarrhoea, sepsis) - being in hospital increases AKI risk

21

Investigations of AKI

full examination, creatinine, urea, electrolytes, liver enzymes, clotting, glucose, urine dipstick, autoantibodies (anti-GBM, ANCA), renal USS
Imaging (CT-KUB?)

22

Things to do before referral to nephrologist

First treat/stabilise and hyperkalemia
Proper history and examination (blood pressure, medication on)
Blood tests & Imaging
IV fluid
Urine dip sticks
Review of drugs
Fluid balance ( intake /output )
Current volume status (dry/dehydrated or wet/HF)

23

When to refer to nephrologist

Treat the urgent causes first !
Hyperkalaemia or fluid overload unresponsive to medical treatment
Urea > 40mmol/L +/- signs of uraemia (e.g. encephalopathy, pericarditis etc)
No obvious cause
Creatinine > 300 or rising > 50micromol/L per day

24

Complications fo AKI

Hyperkalemia
Pulmonary oedema
Uraemia
Acidemia

25

Indications of dialysis

Refractory pulmonary oedema (fluid bluids up in lungs)
Persistent hyperkalaemia (no difference after insulin and dextrose)
Severe metabolic acidosis
Uraemic encephalopathy or pericarditis
Drug overdose – BLAST (Barbiturate,
Lithium,
Alcohol-ethylene glycol,
Salicylate,
Theophylline)

26

Prognosis of AKI - put these in order from highest prognosis to lowest:
Medical illness, Obstetric/poisioning, Trauma/surgery, Burns

Burns, Trauma/surgery, Medical illness, Obstetric/poisioning

27

What % of AKI are preventable

30%

28

Prevention of AKI

Drugs
Diagnose early and give IV fluids to keep hydrated