ACUTE KIDNEY INJURYQuentin 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 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
Age CKD HF Diabetes Surgery Drugs- CANDA Cognitive/neuro impairment
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: 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
General Fluid status: BP, skin turgor, mucous
membranes, JVP, oedema (peripheral/pulmonary), urine output
Abdominal (in exams) Palpable bladder?
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
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
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)
Acidosis Sodium bicarb IV Dialysis
Pulmonary Oedema Sit up O2 Furosemide
Uraemia
Indications for dialysis
1. Hyperkalaemia (refractory)2. Severe acidosis (refractory)3. Severe pulmonary oedema4. Uraemic encephalopathy
Key points
Causes: pre-, renal and post- CANDA Treatment: the cause Manage: the complications (& be aware)
Questions?
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