Acute Kidney Injury

ACUTE KIDNEY INJURY Quentin Oury (FY1) Definition Several!! New Nice guidelines due 2014: a rise in serum creatinine (of 26 mol/l or greater within mol/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: 2) Renal: 3)

Hypovolaemia: sepsis, CCF, D+V, NSAID/ACEi, RAS ATN due to ischaemia/nephrotoxins (drugs/contrast/myeloma/rhabdo) Gomerulonephritis, vasculitis 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+Es : CREATININE

Renal screen: myeloma, vasculitis, rhabdo Imaging CXR USKUB Special Urine PCR CT KUB Renal biopsy

Management Treat the cause! Conservative: Medical Oral fluids, STOP CANDA, diet

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. 2. 3. 4. Hyperkalaemia (refractory) Severe acidosis (refractory) Severe pulmonary oedema Uraemic encephalopathy

Key points Causes: pre-, renal and postCANDA Treatment: the cause Manage: the complications (& be aware) Questions?

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