FN: Acute Kidney Injury Flashcards Preview

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Flashcards in FN: Acute Kidney Injury Deck (27):
1

Definition

Significant decline in renal function over hrs or days manifesting as an abrupt and sustained raise in SE U and CR

2

Causes

Pre-renal and ATN account for 80%

3

Renal causes

ATN:
1. ischaemia: shock, HTN, HUS, TTP
2. Direct nephrotoxins: drugs, contrast, Hb

Acute TIN: drug hypersensitivity
Nephritic syndrome

4

Post-renal

SNIPPIN
Stone
Neoplasm
Inflammation: stricture
Prostatic hypertrophy
Posterior urethral valves
Infection: TB, schisto
Neuro: post-op, neuropathy

5

Presentation

Uraemia/Azotaemia
Acidosis
Hyperkalaemia
Fluid overload:
1. Oedema, inc. pulmonary
2. Raised BP (or decreased)
3. S3 gallop
4. Raised JVP

6

Chronic features

Hx of comorbidity: DM, HTN
Long duration of symptoms
Previously abnormal bloods (GP records)

7

Clinical assessment

Acute or chronic
Volume depleted
GU tract obstruction
RAre cause

8

Volume depleted? signs

Postural hypotension
Reduced JVP
Raised Pulse
Poor skin turgor, dry mucus membranes

9

GU tract obstruction?

Suprapubic discomfort
Palpable bladder
Enlarge prostate
Catheter
Complete anuria (rare in ARF)

10

Rare cause

Assoc. with proteinuria ± haematuria
Vasculitis: rash, arthralgia, nosebleed

11

Investigations

bloods
ABG
GN screen

Urine
ECG
CXR
Renal US

12

Bloods shows

FBC
U+E
LFT
Glucose
Clotting
Ca ESR

13

ABG

Hypoxia (oedema), acidosis, raised K+

14

GN screen

if cause unclear

15

Urine

Dip
MCS
Chemistry (U+E, PCR, osmolality, BJP)

16

ECG show

Hyperkalaemia

17

CXR

Pulmonary oedema

18

Renal US

Renal size
Hydronephrosis

19

NB urine osmolality

In pre-renal failure, urine is concentrate and NA is reabsorbed - raised osmolality, Na

20

Classification

RIFLE classification

21

Treatment general

1. Identify and Rx pre-renal or post-renal causes
2. Urgent US
3. Rx exacerbating factors e.g. sepsis
4. Give PPis
5. Stop nephrotoxins: NSAIDS, ACEi, gent, nac
6. Stop metformin if Cr >150mM

22

Monitoring

Catheterise and monitor UO
Consider CVP
Fluid balance
Wt.

23

Hyperkalaemia features

Peaked T waves
Flattened P waves
Raised PR interval
Widened QRS
Sine-wave pattern - VF

24

Management of Hyperkalaemia

1. 10ml 10% calcium gluconate
2. 100ml 20% glucose + 10u insulin (Actrarapid)
3. Salbutamol 5mg nebuliser
4. Calcium resonium 15g PO or 30g PR
5. Haemogiltration (usually needed if anuric)

25

Pulmonary Oedema

1. Sit up and give high flow oxygen
2. Morphine 2.5 mg IV (±metaclopramide 10mg IV)
3. Frusemide 120-250mg IV over 1h
4. GTN spray ± ISMN IVI (unless SBP

26

Bleeding

Raised urea impairs haemostasis
FFP + Plats as needed
Transfuse to maintain HB >10

27

Indications for Acute Dialysis (AEIOU)

1. Persistant hyperkalaemia (7mM)
2. Refractory pulmonary oedema
3. Symptomatic uraemia: encephalopathy, pericarditis
4. Severe metabolic acidosis (pH

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