AKI Flashcards
How can the causes of AKI be sub-divided?
Give examples of each
Pre-renal: hypovolaemia, decreased CO
Intra-renal: interstitial nephritis, nephrotoxic drugs
Post-renal: renal stones, prostate enlargement
How is AKI diagnosed?
creatinine x 2 and urine output
Rise in serum creatinine of >26 over 48 hours
50% rise in serum creatinine over last 7 days
Fall in UO to <0.5 ml/kg for >6 hours
Remembering values for AKI
Creatinine 26 over 48
Creatinine 50% over 7
OU 0.5 over 6
What should be included in a volume status assessment?
pulse, BP, peripheral perfusion, JVP
Possible signs + symptoms of AKI
Vomiting, diarrhoea, evidence of dehydration
Reduced UO
Confusion, fatigue _ drowsiness
What are the most common causes of AKI?
Sepsis, major surgery, cardiogenic shock, hypovolaemia, drugs (FANG), hepatorenal syndrome, obstruction
What does FANG stand for?
Drugs causing AKI Furosemide ACEi + ARBs NSAIDs Gentamicin
Important investigations in suspected AKI
Renal function, serum potassium, creatinine, Us+Es
Urine dip
USS
LFTs
VOLUME STATUS!!
What is an average urine output?
0.5ml/kg/hour
Other than UO, what are possible sources of fluid loss?
Drains + wounds
What is haematocrit and what may happen in dehydration?
Haematocrit is the ratio of volume of RBCs to total blood volume
Raised in dehydration (i.e. reduced blood volume)
Give 3 reasons for raised urea + creatinine
Dehydration
Chronic renal failure
Urea may be raised in upper GI haemorrhage
Sodium levels in dehydration + fluid overload
Sodium is elevated in dehydration
May be low in fluid overload (diluted hyponatraemia)
Fluid managementin hypovolaemia
Give 500ml 0.9% saline STAT
Reassess fluid status
Give further boluses of 250-500ml if required
Principles of management in pre-renal
Correct volume deplation or increase renal perfusion via circulatory/ cardiac support
Treat any underlying sepsis
