acute kidney injury
DESCRIPTION
Acute Kidney Injury. Finals Teaching 2014 Alison Portes FY1. Objectives. Be able to recognise and define acute kidney injury Understand risk factors for developing AKI Describe causes of AKI I dentify relevant features of history, examination and investigations - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Acute Kidney Injury](https://reader035.vdocuments.net/reader035/viewer/2022081520/5681649b550346895dd677bb/html5/thumbnails/1.jpg)
+
Acute Kidney Injury
Finals Teaching 2014Alison Portes FY1
![Page 2: Acute Kidney Injury](https://reader035.vdocuments.net/reader035/viewer/2022081520/5681649b550346895dd677bb/html5/thumbnails/2.jpg)
+Objectives
Be able to recognise and define acute kidney injury Understand risk factors for developing AKI Describe causes of AKI Identify relevant features of history, examination and
investigations Know key features of management of both AKI and
hyperkalaemia
![Page 3: Acute Kidney Injury](https://reader035.vdocuments.net/reader035/viewer/2022081520/5681649b550346895dd677bb/html5/thumbnails/3.jpg)
+Which of these patients has AKI? 89 year old lady found on the floor by her carer, Ur 7,
Creat 190
50 year old presenting at A&E following 2 days of severe vomiting and diarrhoea, Ur 20 Creat 205
70 year old on the ward being treated for CAP, nurses are concerned he is not passing urine
![Page 4: Acute Kidney Injury](https://reader035.vdocuments.net/reader035/viewer/2022081520/5681649b550346895dd677bb/html5/thumbnails/4.jpg)
+Definition
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)
“Rise in serum creatinine from normal baseline over hours or days”
![Page 5: Acute Kidney Injury](https://reader035.vdocuments.net/reader035/viewer/2022081520/5681649b550346895dd677bb/html5/thumbnails/5.jpg)
+Causes
Pre-renal (hypoperfusion) Hypovolaemia Sepsis Drugs e.g., NSAIDs Renal artery stenosis
Renal Glomerulonephritis Drugs e.g., gentamicin Rhabdomyolysis Myeloma Haemolytic-uraemic syndrome
Post-renal (obstruction) Tumours BPH Retroperitoneal fibrosis
![Page 6: Acute Kidney Injury](https://reader035.vdocuments.net/reader035/viewer/2022081520/5681649b550346895dd677bb/html5/thumbnails/6.jpg)
+History
Think of causes: Infection (UTI/sepsis) Hypovolaemia (D+V, acute blood loss) Drugs (any nephrotoxic/new meds?) Urine: output (&symptoms of UTI/prostate) Weird and wonderful (nosebleeds, haemoptysis,
backpain/weight loss) PMHx: Diabetes, bladder/prostate Ca, FHx (PKD)
![Page 7: Acute Kidney Injury](https://reader035.vdocuments.net/reader035/viewer/2022081520/5681649b550346895dd677bb/html5/thumbnails/7.jpg)
+Examination
General Fluid status: BP, skin turgor, mucous membranes, JVP,
oedema (peripheral/pulmonary), urine output Abdominal (in exams)
Palpable bladder? Ballotable kidneys?
![Page 8: Acute Kidney Injury](https://reader035.vdocuments.net/reader035/viewer/2022081520/5681649b550346895dd677bb/html5/thumbnails/8.jpg)
+Investigations
Observations Bedside
Urine Dip, ECG, ABG, BM
Bloods FBC, U&Es, renal screen – complement, autoantibodies, myeloma screen
Imaging USS renal tract CXR
Special tests Biopsy
![Page 9: Acute Kidney Injury](https://reader035.vdocuments.net/reader035/viewer/2022081520/5681649b550346895dd677bb/html5/thumbnails/9.jpg)
+Management of AKI
Treat the cause! Conservative:
Oral fluids, STOP CANDA, diet Medical
IV fluids, treat life-threatening complications, catheter (if bladder/prostate obstruction), steroids for certain types of GN
Dialysis Surgical
Obstruction, bleeding
![Page 10: Acute Kidney Injury](https://reader035.vdocuments.net/reader035/viewer/2022081520/5681649b550346895dd677bb/html5/thumbnails/10.jpg)
+Complications of AKI
Hyperkalaemia Metabolic Acidosis Pulmonary Oedema Uraemia
![Page 11: Acute Kidney Injury](https://reader035.vdocuments.net/reader035/viewer/2022081520/5681649b550346895dd677bb/html5/thumbnails/11.jpg)
+ECG changes in hyperkalaemia
Tall tented T waves Low flat P waves Broad, bizarre QRS
![Page 12: Acute Kidney Injury](https://reader035.vdocuments.net/reader035/viewer/2022081520/5681649b550346895dd677bb/html5/thumbnails/12.jpg)
+Treatment of hyperkalaemia
Protect the heart Monitor Calcium Gluconate
Shift the potassium Insulin/dextrose Salbutamol nebs
Treat the cause Reassess
![Page 13: Acute Kidney Injury](https://reader035.vdocuments.net/reader035/viewer/2022081520/5681649b550346895dd677bb/html5/thumbnails/13.jpg)
+Indications for Dialysis
AEIOU Acidosis – refractory metabolic acidosis Electrolyte imbalance (refractory hyperkalaemia) Intoxication – poisoning with dialysable substances Overload – refratory pulmonary oedema Uraemic symptoms – pericarditis, encephalopathy
![Page 14: Acute Kidney Injury](https://reader035.vdocuments.net/reader035/viewer/2022081520/5681649b550346895dd677bb/html5/thumbnails/14.jpg)
+Key points History and Examination – concentrate on doing the basics
well Investigations – what differential will it rule out? Learn the essentials now and keep repeating them…
Pre-renal, renal, post-renal CANDA ECG changes in hyperkalaemia Treatment of hyperkalaemia Indications for dialysis
Practice communication task Questions?