AKI

AKI

1. causes

   • pre-renal
     • sepsis
       • infection
     • hypovolaemia
       • D&V
       • blood loss
     • drugs affecting perfusion
       • ramipril
       • bendroflumethiazide
     • shock/burns
   • renal
     • nephrotoxic drugs
       • interstitial nephritis
         • NSAIDs
         • antibiotics
           • gentamycin
     • vasculitis
     • rhabdomyolysis
     • myeloma
   • post-renal
     • obstruction
       • stones
       • BPH
       • malignancy

2. management

   • 'STOP'
     • sepsis & hypoperfusion
       • fluid challenge 500-1000ml
       • Sepsis Six
     • toxins
       • stop meds affecting kidney
     • obstruction
       • renal USS
     • parenchymal disease
       • urine dipstick
         • blood + protein
           • glomerulonephritis
   • critically ill
     • SpR, ITU
   • hyperkalaemia
     • cardioprotection (30 mins
       • 10ml 10% IV calcium gluconate
     • reduce K+
       • insulin/dextrose
         • 10 units Actrapid in 50ml ml 50% dextrose
     • dialysis

3. symptoms/signs

   • oliguia
     • urine volume less than 0.5 ml/kg/hour) for 6 hrs
   • anuria
     • <100ml/day
   • dehydration
     • big drop in postural HTN on lying/standing BP
     • cap refill > 2 s
   • confusion
   • D & V
   • obs
     • signs of infections
       • BP
       • pulse
   • fluid overload
     • raised JVP
     • bibasal crepitations
     • peripheral oedema

4. investigations

   • Bloods
     • FBC
     • U&E
       • > 50% rise in creatinine from baseline
       • raised urea
       • hyperkalaemia
         • K+ > 6.5
     • LFTs
     • raised CRP
     • culture
   • urine dipstick
   • stool sample
     • M, S & C
   • ECG
     • broad QRS
     • tented T waves
     • prolonged PR interval
     • absent p waves
   • ABG
   • CXR

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