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Acute Kidney Injury

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

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  1. Acute Kidney Injury Quentin Oury (FY1)

  2. 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

  3. Risk factors • Age • CKD • HF • Diabetes • Surgery • Drugs- CANDA • Cognitive/neuro impairment

  4. 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

  5. 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)

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

  7. 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

  8. 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

  9. 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

  10. Complications (cont) • Acidosis • Sodium bicarb IV • Dialysis • Pulmonary Oedema • Sit up • O2 • Furosemide • Uraemia

  11. Indications for dialysis • Hyperkalaemia (refractory) • Severe acidosis (refractory) • Severe pulmonary oedema • Uraemic encephalopathy

  12. Key points • Causes: pre-, renal and post- • CANDA • Treatment: the cause • Manage: the complications (& be aware)

  13. Questions?

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