ACUTE KIDNEY INJURY Quentin Oury FY 1 Definition

ACUTE KIDNEY INJURY Quentin Oury (FY 1)

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 e. GFR 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) Hypovolaemia: sepsis, CCF, D+V, NSAID/ACEi, RAS Renal: ATN due to ischaemia/nephrotoxins (drugs/contrast/myeloma/rhabdo) � Gomerulonephritis, vasculitis � 3) 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: � � Bloods � � FBC and regular tests inc cultures “U+E’s” : CREATININE Renal screen: myeloma, vasculitis, rhabdo Imaging � � � Urine dipstick, urine input/output, daily weights/fluid monitoring ABG/VBG ECG CXR USKUB Special � � � Urine PCR CT KUB Renal biopsy

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

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 O 2 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 post. CANDA Treatment: the cause Manage: the complications (& be aware)

Questions?