AKI/SEPSIS Flashcards
(21 cards)
what is the definition of AKI?
creatinine increase >26umol/L within 48hrs
creatinine increase >1.5 x baseline over 7 days
UO <05.ml/kg/hr for 6 consecutive hours
what are the risk factors for AKI?
male age pre-existing CKD DM CVD malignancy
how is the severity of AKI staged?
KDIGO staging system- staged according to highest creatinine rise or longest / most sustained period of oligouria
what are the causes of pre-renal AKI? (6)
sepsis cardiogenic shock dehydration hypotension CCF renal artery stenosis (bilateral)
what are the causes of renal AKI? (7)
drugs (the 4 A's = Acei, Arb, nsAids, gentAmicin) glomerulonephritis vasculitis contrast interstitial nephritis myeloma rhabdomyolysis
how would you expect the U’s and E’s to look from a dehydrated patient?
increase in gross increase in urea, creatinine normal or mildly elevated
albumin and haematocrit may also be raised
how is hyperkalaemia diagnosed? What are the ECG findings associated with hyperkalaemia?
VBG
ECG - prelonged PR, stunted p waves, broad QRS, tented/peaked t waves
what electrolyte should you correct before attempting to correct a hyperkalaemia?
Mg2+
what are the causes of post-renal AKI?
blockage distal to urinary apparatus
kidney stones pelvic Ca hydronephrosis urinary retention BPH
what is the definition of sepsis?
life-threatening organ dysfunction in response to dyspregulated host response to infection
what is the definition of septic shock?
lactate +2 despite fluid resuscitation
vasopressor requirements for MAP 65
what is the salford criteria of AKI?
Sepsis A acei, arb, nsAids L labs- take U + E, cultures F fluid assessment and response O obstruction R renal / ICU referral D dipstick the urine
what are the indications for dialysis in AKI?
not recommended if condition is not life-threatening
A acidosis (metabolic) E electrolyte imbalances (refractory hyperkalaemia) I intoxication O oedema (refractory pulmonary oedema) U uraemia (clinical syndrome of high urea)
what is the definition of sepsis?
life threatening organ dysfunction caused by host responses to infection
how is septic shock defined?
lactate >2mmol despite fluid resuscitation
vasopressor requirement for MAP of 65
with regards to NICE sepsis risk stratification guidelines, what parameters make a patient high risk?
altered mental state RR +25 40%FiO2 systolic BP less than 90 tachycardia more than 130bpm cyanosis, non blanching rash
why is it important to check clotting screens in septic patients? (2 reasons)
used as a marker to indicate sepsis severity
septic patients are often in a hypercoagulopathic state which can lead to DIC
what are the three phases of acute tubular necrosis? How does creatinine reflect the different phases?
oligouric phase (high creatinine, low UO, often hypervolaemic) maintenance phase (creatinine normal, pt maintains own fluid balance) polyuric 'recovery' phase (patients polyuric, can easily become hypovolaemic)
by which mechanism do ACEi/ARB cause nephrotoxicity?
efferent renal arteriole dilatation
this lowers glomerular filtration rate
by which mechanism do NSAIDs cause nephrotoxicity?
vasoconstriction of afferent arteriole
this can cause pre-renal hypovolaemic AKI
what electrolyte marker is used to differentiate between chronic and acute kidney injury?
Calcium
hypocalcaemia in chronic kidney disease
