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Acute Kidney Injury. Quentin Oury (FY1). Definition. Several!! New Nice guidelines due 2014: a 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

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acute kidney injury

Acute Kidney Injury

Quentin Oury (FY1)

definition
Definition
  • Several!! New Nice guidelines due 2014:
    • a 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
    • a fall in urine output (to less than 0.5 ml/kg/hour for more than 6 hours in adults and more than 8 hours in children and young people)
    • a 25% or greater fall in eGFR in children and young people.
  • Put simply : Rise in serum creatinine over hours/days/weeks
risk factors
Risk factors
  • Age
  • CKD
  • HF
  • Diabetes
  • Surgery
  • Drugs- CANDA
  • Cognitive/neuro impairment
causes
Causes
  • Pre-renal:
    • Hypovolaemia: sepsis, CCF, D+V, NSAID/ACEi, RAS
  • Renal:
    • ATN due to ischaemia/nephrotoxins (drugs/contrast/myeloma/rhabdo)
    • Gomerulonephritis, vasculitis
  • Post-renal:
    • Obstruction
history
History
  • Think of causes:
    • Infection (UTI/sepsis)
    • Hypovolaemia (D+V, acute blood loss)
    • Drugs (any nephrotoxicx/new meds?)
    • Urine: output (&symptoms of UTI/prostate)
    • Weird and wonderful (nosebleeds, haemoptysis, backpain/weight loss)
    • PMHx: Diabetes, bladder/prostate Ca, FHx (PKD)
examination
Examination
  • General
  • Fluid status: BP, skin turgor, mucous membranes, JVP, oedema (peripheral/pulmonary), urine output
  • Abdominal (in exams)
    • Palpable bladder?
investigations
Investigations
  • Bedside:
    • Urine dipstick, urine input/output, daily weights/fluid monitoring
    • ABG/VBG
    • ECG
  • Bloods
    • FBC and regular tests inc cultures
    • “U+E’s” : CREATININE
    • Renal screen: myeloma, vasculitis, rhabdo
  • Imaging
    • CXR
    • USKUB
  • Special
    • Urine PCR
    • CT KUB
    • Renal biopsy
management
Management
  • Treat the cause!
  • Conservative:
    • Oral fluids, STOP CANDA, diet
  • Medical
    • IV fluids, treat life-threatening complications (next slide), catheter (if bladder/prostate obstruction), steroids for certain types of GN
    • Dialysis (if needed-see later)
    • Diuretics (if actually CKD crash-lander)
  • Surgical
    • Obstruction, bleeding
complications
Complications
  • Hyperkalaemia:
    • Life-threatening
      • ECG signs:
      • Low/flat P-waves,
      • Broad QRS
      • Tall-tented T waves
    • Mx:
      • 1-Calcium gluconate (10/10) IV
      • 2-Insulin+dex IV
      • 3-Salbutamol
      • 4-Calcium resonium
complications cont
Complications (cont)
  • Acidosis
    • Sodium bicarb IV
    • Dialysis
  • Pulmonary Oedema
    • Sit up
    • O2
    • Furosemide
  • Uraemia
indications for dialysis
Indications for dialysis
  • Hyperkalaemia (refractory)
  • Severe acidosis (refractory)
  • Severe pulmonary oedema
  • Uraemic encephalopathy
key points
Key points
  • Causes: pre-, renal and post-
  • CANDA
  • Treatment: the cause
  • Manage: the complications (& be aware)