MedEd renal 1 Flashcards
(87 cards)
What is AKI?
Sudden rapid reduction in eGFR with or without oligouria
What criteria is used in AKI
Kdigo
What is Kdigo’s criteria and what is it used for
Used to diagnose AKI
Serum cr= 1.5-1.9 baseline or >26 umol/L increase
Urine output= <0.5mL/kg/h for 6-12 hrs
How much does serum cr rise in AKI?
eGFR 1.5-1.9 x baseline
eGFR >26 umol/L increase
What is stage 1 AKI according to Kdigo’s criteria?
normal Kdigo criteria
eGFR 1.5-1.9 x baseline or >26 umol/L
urine output <0.5 ml/kh/h for 6-12 hrs
What is AKI stage 2 according to Kdigo’s criteria?
eGFR 2-2.9 x baseline
urine output <0.5 l/kh/h for >12 hrs
What is AKI stage 3 according to Kdigo’s criteria?
creatinine 3 x baseline or >354 umol/L
urine output <0.3 ml/kh/h for 24 hrs or anuria for 24 hrs
anyone on renal replacement therapy
What is urine output in AKI?
<0.5mL/kg/hr for 6-12 hrs
What are the 4 complications of AKI? What symptoms does each cause and how is it managed?
Fluid overload- pulmonary oedema, treat with IV furosimide/GTN infusion and heamolysis if refractory
Uraemia- uraemic encephalitis (lethargy and confusion), uraemic pericarditis, treat with haemodialysis
Metabolic acidosis- confusion, tachycardia, jussmaul’s breathing, NV, treat with IV/PO sodium bicarb and dialysis if refractory
Hyperkalemia- asymptomatic, arrhythmia, muscle weakness, cramps, paarsthesia, hypotension, bradycardia, cardiac arrest, treat with connecting to cardiac monitor, calcium gluconate 10% 30 ml IV, 10 units soluble insulin (drives K+ into cells), 50 mls of 50% glucose (to avoid hypo)
What symptom does fluid overload cause in AKI and how is this managed?
Causes pulmonary oedema
Treat with IV furosimide/GTN infusion and heamolysis if refractory
What symptom does uraeamia cause in AKI and how is this managed?
Causes uraemic encephalitis (lethargy and confusion), uraemic pericarditis
Treat with haemodialysis
What symptom does metabolic acidosis cause in AKI and how is this managed?
Causes confusion, tachycardia, jussmaul’s breathing, NV
Treat with IV/PO sodium bicarb and dialysis if refractory
What are mild, moderate and severe levels for hyperkalemia
Mild= 5.5-6 Moderate= 6.1-6.5 Severe= over 6.5 or any level with ECG changes or if symptomatic
What symptom does hyperkaelmia cause in AKI and how is this managed?
asymptomatic, arrhythmia, muscle weakness, cramps, paarsthesia, hypotension, bradycardia, cardiac arrest
Treat with connecting to cardiac monitor, calcium gluconate 10% 30 ml IV, 10 units soluble insulin (drives K+ into cells), 50 mls of 50% glucose (to avoid hypo)
What ECG changes are seen in hyperkalemia
Tall tented T waves Prolonged PR Wide QRS Flattened/ absent p wave Sinusoid rhythm
How do you remember doses for hyperkaelmia treatment?
10, 10, 50, 50
10% 30ml IV calcium gluconate
10 units insulin
50ml 50% glucose
What ix are done for AKI?
Fluid assessment
ABG/VBG
Bloods: UEs, FBC, CRP, LFTs, CK, clotting
Hep screen, HIV screen, vasculitic screen, myeloma screen, anti GBM, sepsis screen if septic
KUB
ECG
Take a good drug hx!!
What aspect of the hx is really important in AKI?
Drug hx
How is AKI managed?
ABCDE approach Find and treat cause Stop any nephrotoxic drugs Fluid manage (IV fluids or offload with diuretics or dialysis) Treat complications Dialysis if needed
What common abx often causes AKI?
Amoxicillin
What causes AKI?
Pre renal= problems with blood supply
Renal= problems with kidney tissue
Post renal= problems with urine outflow
Why might there be decreased kidney perfusion causing pre renal AKI?
Hypovolemia eg acute GI loss, haemorrhage, diuresis, burns, third spacing
Low volume eg heart failure or liver failure
Vascular insult- damage to arteries/arterioles supplying kidneys
What 3 things will cause reduced perfusion to the kidneys?
Hypovolemia
Low volume
Vascular insult
What might damage arteries/arterioles supplying the kidneys?
ACEi/ARBs
NSAIDs
Contrast
Renal artery stenosis
