AKI

AKI

1. Significant deterioration in renal function over hours, days to weeks, rapid fall in GFR, > creatinine & urea levels, may be reversible

2. Pre-renal: hypovolaemia, shock, hypoperfusion, ACE-I use, oedematous conditions (HF & nephrotic syndrome)

   • Intrinsic: glomerular disease, vascular lesions, tubulointerstitial disease
     • Postrenal: obstruction of the ureter, bladder neck or urethra

3. S&S: oliguria/anuria, N&V, confusion, HPT, abdo/flank pain, >JVP (fluid overload)

4. Tests: >serum creatinine & urea, urea:creatinine ratio (<40:1 renal; >100:1 pre-renal; 40-100:1 normal or postrenal), hyperkalaemia (pro-arrhythmic = peaked T waves, increased PR interval, widened QRS) & metabolic acidosis; urinalysis & renal US

5. Mgt: maintain renal blood flow & fluid balance, monitor electrolytes, treat underlying cause (RIFLE: risk, injury, failure, loss, end-stage), stop all nephrotoxic drugs, RRT