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Flashcards in AKI Deck (9):
1

Symptoms of AKI

Fatigue
Weight loss
Nocturia
Oliguria
Haematuria

2

Signs of AKI

Rash
Hypotension/hypertension
Signs of HF
Palpable bladder - obstructive

3

Specific questions in an AKI history

Volume restriction?
Nephrotoxic medications?
Trauma?
Blood loss?
History of renal stones/ abdominal surgery/ prostatism?

4

3 types of AKI and causes

PRERENAL: due to reduced renal perfusion, untreated leads to ATN
- Reduced ECF volume in hypovolaemia/systemic vasodilation/HF
- impaired renal autoregulation eg. Sepsis/drugs (NSAIDs, ACEIs)

RENAL: direct injury to the kidney
- Acute tubular necrosis due to ischaemia or nephrotoxins
- Acute Glomerulonephritis: immune disease eg. IgA Nephropathy, SLE
- Acute Tubulo-interstitial nephritis: inflammation of kidney interstitium due to infection/toxins

POSTRENAL: obstruction to urine flow, dilates renal pelvis (hydronephrosis), impairs renal function
- within lumen eg. Stones/ within wall eg. Stricture post TB/ pressure from outside eg. Malignancy, AAA

5

Investigations of AKI

FBC - increased urea & creatinine, hyperkalaemia, hyponatraemia
Urine dipstick - Haematuria, proteinuria, leucocytes
Urine microscopy - Hyaline cast (prerenal), muddy brown cast (ATN)
Antibody assays
Kidney biopsy

6

Management of AKI

Depends on cause
Eg. Give fluids in hypovolaemia

ATN: fluid restriction, avoid nephrotoxins

Can use dialysis if hyperkalaemia and fluid overload persists despite treatment, or in presence of a dialysable nephrotoxin

7

Prognosis of AKI

If uncomplicated, patient usually recovers in 2-3 weeks
Mortality rate = 25%
Increased risk of developing CKD

8

What criteria is used to diagnose AKI

One of:
- Serum creatinine >26.5 micromol/L in 48hrs
- Serum creatinine >1.5 X baseline within 7 days
- Urine output <0.5ml/kg/hr for >6hrs

9

AKI differentials

CKD
Heart failure
Diabetic ketoacidosis/metabolic acidosis
Dehydration
UTI