Acute Kidney Injury

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Acute Kidney Injury- Handout
Definition (NICE 2014)
Sudden deterioration in renal function over hours/days.
 rise in serum creatinine (of 26 μmol/l or greater within 48 hours)
 a 50% or greater rise in serum creatinine known or presumed to have
occurred within the past 7 days
 decreased urine output (normal 0.5ml/kg/hour normal)
Risk factors
Age
CKD
HF
Diabetes
Drugs -CANDA
Surgery
Causes
1) Pre-renal:
 Hypovolaemia: sepsis, CCF, D+V, NSAID/ACEi, RAS
2) Renal:
 ATN due to ischaemia/nephrotoxins (drugs/contrast/myeloma/rhabdo)
 Gomerulonephritis, vasculitis
3) Post-renal:
 Obstruction
History
Think of causes!
Examination
-Fluid status (overloaded/dehydrated): BP, skin turgor, cap refill, mucous membranes, JVP,
pulmonary oedema, peripheral oedema.
-Abdo exam
Investigations
Bedside
Urine dip, ABG, ECG
Bloods
U+Es, FBC, +standard
Imaging
USKUB, CXR
Special
Biopsy, CTKUB, PCR
Management
Treat the cause! Treat the complications!
Conservative: fluids, stop CANDA,
Medical: catheter, IV fluids, dialysis
Surgical: for obstruction (e.g. nephrostomies)
Hyperkalaemia
ECG signs: low/flat p-waves, Broad QRS, slurred ST segment, Tall/tented T-waves
Emergency Mx: Ca gluconate, Insulin/dex, Salbutamol nebs, Ca resonium
Other complications of AKI (&indications for dialysis)
-Acidosis
-Pulmonary oedema
-Uraemia
Nephrotoxic drugs/drugs that can cause AKI (CANDA)
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Contrast
ACE-i/ARB
NSAIDS
Diuretics
Aminoglycosides (Gent)
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