Emergency medicine: urinary (incl AKI) Flashcards
What is the definition criteria for AKI?
- > 26umol increase in creatinine in 48hrs
- > 50% increase in creatinine over 7d
- > 0.5ml/kg/hr of UO over 6hrs (adult), 8hrs (child)
- 25% decrease in eGFR over 7 d (child)
What are the categories and main causes of AKI?
- Pre-renal - Hypovolaemia (dehydration, sepsis, bleed, vomiting, burns), nephrotic synd (most common in child), renal artery stenosis, HF
- Renal - glomerulonephritis, nephrotoxic drugs, pyelonephritis, HUS,
- Post-renal - obstructive i.e. renal stone or trauma
What is the definition of HUS and state the symptoms? Who does it affect?
A triad of microangiopathic haemolytic anaemia, thrombocytopenia, acute renal failure
Typically affects infants and toddlers in summer/autumn
- Diarrhoea +ve (if e.coli0157) or Diarrhoea -ve (if atypical/sporadic)
- General: Fever, abdominal pain, bloating
- Gut: diarrhoea turns bloody (after 1-3d), haemorrhagic colitis, rectal prolapse, bowel wall necrosis
- Pancreas: jaundice, DM, neuro irritability, encephalopathy
What are the symptoms and definition of nephrotic syndrome?
Nephrotic syndrome occurs due to damage of the glomerulus due to MCD (child) or glomerulonephritis (adult) –> microalbuminaemia
Definition:
- Hyperalbuminuria: protein:creatinine ratio (ACR) > 200
- Hyperalbuminaemia > 25 g/l
Symptoms:
- Periorbital or genital oedema
- Ascites
- Oliguria, frothy urine
- Abdominal pain
- Diarrhoea
- Anorexia
What is the general management for AKI?
- ABCDE - treat cause
- Oxygen
- Fluids 500ml bolus
- Hyperkalaemia - 10ml of calcium gluconate, 10units of Actrapid insulin in 50ml of 50% dextrose, salubutamol news over 15 mins
What is the treatment for hyperkalaemia?
- Calcium gluconate IV (10mls of 10% over 15 mins)
- repeat until K+ corrects itself - Salbutamol nebs (5mg)
- drives K+ into cells - Insulin and dextrose IV (10 units of Actapraid in 50mls of 50% dextrose)
- over several hours
How do you treat metabolic acidosis?
- IV Bicarbonate (8.3%) - 50-100mls over 30 mins
How do you treat dehydration in AKI?
- Saline 0.9% (500ml over 30 mins)
- do not try Hartmann’s as it contains 5mmols of K+, which may potentiate hyperkalaemia
What are the common causes for urinary retention in males, females?
MALES:
Benign prostatic hypertrophy
Prostate cancer
Urethral stricture post-op
FEMALES:
Retrogravid uterus
Pregnancy
MS
Other causes:
urethritis, prostatitis, bladder clot, faecal impaction, drugs, SCC
What are the symptoms and signs of urinary retention?
Distended Bladder Reduced UO - Oliguria or Anuria Lower abdominal pain, discomfort or tenderness Dull percussion over bladder Delirium (if elderly, it is common)
What is the management for acute urinary retention?
- Catheterise - urethral (1st line) or suprapubic (2nd line)
- Measure bladder content - 400-500ml (normal), 1L (abnormal - retention)
- MSC urine - determine cause
- Reassess abdominal exam - may have masked something more sinister
- Monitor U+E, fluid intake and UO
- Refer to Urology
- Later TWOC (trial without catheter)
What is the investigative pathway for renal stones?
- Urine dip - blood +
2. US or CT KUB - visualise stone
What is the treatment for renal stones?
- Analgesia
- NSAIDS PO - Diclofenac (1st line)
- Morphine (2nd line) - Tamsulosin (a blocker)
- Relaxes SM of bladder and prostate, allows stone to pass through naturally - Shock wave lithotripsy
What is the examination and investigation pathway for torsion?
- Abdominal exam
- Examine abdomen
- Examine both testis - I/L pain, swelling, red,
- Angell’s sign - C/L testicle appears horizontal rather than vertical
- Transillumination to rule out hydrocele - Doppler USS
- Both testis
- Examine reduced blood flow in I/L testicle
What is the treatment for testicular torsion?
What is the time frame?
- Surgery
- within 6-12 hours
- untwist I/L testis
- fixate C/L testis, as it may have a tendency to also become totted i.e. “bell clapper” testis
