AKI

Question 1

AKI Causes

Answer 1

• Prerenal (hypotension, oedematous states, cardiovascular (CF, arrhythmias))
• Intrinsic (glomerular disease, tubular injury, interstitial nephritis due to drugs, infection or autoimmune disease)
• Postrenal (calculus, clot, stricture)

Question 2

AKI Epidemiology

Answer 2

15% of adults admitted to hospital develop AKI, common in elderly

Question 3

AKI RFs

Answer 3

CKD, previous, co-existing illness, neurological impairment, hypovolaemia, sepsis, age, iodinated contrast agents, nephrotoxins

Question 4

AKI Presentation

Answer 4

Oliguria and a rise in serum creatinine
AKI is associated with at least 1 of the following
-Rise in serum creatinine of 26 or greater within 48 hours
-50% or greater increase in serum creatinine within preceding 7 days
-Fall of urine output to less than 0.5mL/kg for more than 6 hours

Question 5

AKI Symptoms and Signs

Answer 5

• Oliguria (can get polyuria), nausea/vomiting, dehydration, confusion
• Hypertension, large painless bladder, fluid overload, dehydration, signs of DIC, pericardial rub

Question 6

AKI Ix

Answer 6

Guided by clinical suspicion

• Blood tests
• USS (obstruction suspected or no cause identified)
• Other radiology where appropriate

Question 7

AKI Differentials

Answer 7

• CKD (factors suggesting CKD are; long duration, nocturia, absence of acute illness, anaemia, hyperphosphataemia, hypocalcaemia, renal USS)
• Acute on chronic

Question 8

AKI Management

Answer 8

Mostly supportive

• STOP AKI
• Monitor creatinine, sodium, potassium, calcium, phosphate, glucose

Question 9

AKI Acute Complications

Answer 9

Hyperkalaemia, acidosis, pulmonary oedema, bleeding