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Flashcards in Acute Kidney Injury (AKI) Deck (19):
1

Define Acute kidney injury

An abrupt (<48hours) reduction in kidney function defined as
-an absolute increase in serum creatinine by >26.4umol/litre
OR
increase in creatinine by >50%
OR
reduction in UO
(can be applied once there has been adequate fluid resuscitation and exclusion of obstruction)

2

Risk Factors for AKI
(Patient related)

Older Age
CKD
Diabetes
Cardiac Failure
Liver disease
PVD
Previous AKI

3

Risk factors for AKI
(exposure related)

Hypotension
Hypovolaemia
sepsis
Deteriorating NEWS
Recent contrast
Exposure to certain medications

4

Pre-renal causes of AKI

Hypovolaemia - due to hemorrhage or volume depletion (e.g. in burns)
Hypotension - cardiogenic (or distributive) shock
Renal Hypoperfusion- NSAIDS, hepatorenal syndrome, COX-2, ACEi/ARBs

5

What is pre-renal AKI

A reversible volume depletion leading to oliguria and increased creatinine

6

What can untreated pre-renal AKI lead to?

Acute tubular Necrosis
(This is caused by decreased renal perfusion due to a combination of factors)

7

Treatment of pre-renal AKI

Asses for hydration (through clinical obs and NEWS)
Give initial bolus of fluid - either crystalloid or colloid
DO NOT GIVE DEXTROSE 5%
If patient has received >1000mls and no improvement, seek help

8

What is renal AKI

Caused by diseases which lead to inflammation or damage to cells

9

Causes of renal AKI

Vascular
Glomerular
Interstitial Nephritis (e.g. drugs, TB, systemic)
Tubular Injury (e.g. ischemia, drugs, rhabdomyolysis)

10

Signs and Symptoms of AKI

Non specific symptoms:
Nausea & Vomiting
Itch
Oedema & SOB
Anorexia/weight loss/lethargy
Signs:
Uraemia with itch
Oliguria
Pericarditis
Fluid overload causing oedema, effusions and HTN

11

Initial investigations for AKI

Urinalysis
Us and Es
FBC and clotting screen
USS
Immunology
Protein electrophoresis and BJP

12

When would you do a biopsy?

If urgent indications e.g. suspicious of RPGN or positive immunology
OR if the AKI is unexplained and we need to rule out obstruction

13

What are some life threatening complications of AKI

Hyperkalaemia
Fluid overload
Severe Acidosis
Uremic Pericardial effusion
Severe Uraemia

14

What is post renal AKI

This is AKI due to an obstruction of urine flow leading to back pressure, which in turn causes the loss of concentrating ability

15

Some causes of post renal AKI

Stones
Cancers
Strictures
Extrinsic pressure

16

Treatment for post renal AKI

Relieve the obstruction (either through catheter or nephrostomy)

17

What renal problem is often associated with cardiac arrhythmia's?

Hyperkalaemia

18

What is rhabdomyolysis

a serious syndrome due to direct/indirect muscle damage resulting in muscle fibre death and release of these contents into the blood stream which results in complications e.g. renal failure

19

What do you need to monitor patients for after the AKI has been treated?

Chronic kidney disease
patients should be monitored for at least 2-3 years post AKI and be informed about their risks of developing CKD