1 / 14

Acute Kidney Injury

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

corby
Télécharger la présentation

Acute Kidney Injury

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Acute Kidney Injury Finals Teaching 2014 Alison Portes FY1

  2. 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

  3. 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 Creat205 • 70 year old on the ward being treated for CAP, nurses are concerned he is not passing urine

  4. Definition • Arise in serum creatinine (of 26 μmol/l or greater) within 48 hours) • A50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days • Afall 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 creatininefrom normal baseline over hoursor days”

  5. 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

  6. 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)

  7. Examination • General • Fluid status: BP, skin turgor, mucous membranes, JVP, oedema (peripheral/pulmonary), urine output • Abdominal (in exams) • Palpable bladder? • Ballotable kidneys?

  8. 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

  9. 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

  10. Complications of AKI • Hyperkalaemia • Metabolic Acidosis • Pulmonary Oedema • Uraemia

  11. ECG changes in hyperkalaemia • Tall tented T waves • Low flat P waves • Broad, bizarre QRS

  12. Treatment of hyperkalaemia • Protect the heart • Monitor • Calcium Gluconate • Shift the potassium • Insulin/dextrose • Salbutamol nebs • Treat the cause • Reassess

  13. 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

  14. 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?

More Related