Kidney Scenarios

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Acute kidney injury

Rapid reduction in renal function

In humans GFR decreased, increased creatine, reduction in urine output

AKI and AKIN

Causes

Decreased renal perfusion

Decreased CO

Heart failure

Servere trauma

Tamponade

Cardia arrest

Dysrhythmia

Hyper/Hypothermia

Prolonged urinary tract obstruction

Inc renal vascular resistance

Systemic inflammatory response syndrome

Renal hyper tension

Hypoxia

Drug + toxins

Sepsis

Liver failure

NSAIDS

Early detection less likely

Patients presenting shock

Dec renal perfusion

Angiotensin 2 + Noradrenaline result in vasoconstriction decreasing renal blood flow

Prostaglandins counteract vasoconstriction

NSAIDS not used

Care with use of nephrotoxic drugs

Monitor creatine to allow early diagnoses in patients with Heart or kidney issues r haemoysis / serve muscle injury

Don't use ace inhibitors

V challenging to treat

Acute on chronic kidney disease

USG 1.008 + 1.015

> pre renal compete to elevations in creatine

Dehydration?

dry mm

acute drop in weight

Inc pcv

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0.07 x 30 x1000/24 = 87.5 ml per hr

2100ml per day

2x30 x 24 = 1440 ml/day

1440 +2100 =3540 ml/day

Drip rate

20 drops per mil

3540 x 20 = 70800 drops per 24 hrs

2950 per hour

49.2 drops per min

0.8 drops per sec

4 drops per 5 secs

1/0.82 = 1.27 secs between drops

V little volume of urine

Expect 60 ml ----- dehydrated

Specific gravity within 1.008-1.015

Expect >1.025 ----------- low = AKI

Must be intrinsic renal disease ------cant concentrate urine , low SG

Cause -eaten something it shouldnt i.e. raisins , antifreeze

Pre renal - poor perfusion to kidney

-highly concentrated urine (Animal compensating for poor perfusion)

e.g. cardio vascular disease , blood loss

Prerenal = still concentrate

Fluid overload?

Chemosis

Oedema

Bulk flow

MONITOR patient

v high urea - azotemic

v high creatine

Na fine

K high

Glucose fine

High phosphate

Creatine - muscle

Urea - breakdown of proteins, produced by liver

K+ /H+ pump

aldosterone

Phosphate see later

Metabolic acidosis

GFR decreased

pH higher

HCO3- decreased - can't reabsorb

K+ increased to remove H+ ( try to maintain pH)

pp of O2 and CO2 normal

Compensation - decreased CO2

Acute kidney Injury = rapid reduction in renal function (less than 48 hrs)

Treatment

Benazepril - ACE inhibitor

reduces blood pressure - prevents vasoconstriction (often occurs in kidney problems)

Supportive therapies = correction of fluid deficits

= treatment of electrolyte imbalances

vomiting = azoteamia makes them feel sick

chemoreceptors in brain pick up nitrogen

urea is irritant to gut