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Acute kidney Injury

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Acute kidney Injury

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This chart presents a summary of recognition and management of AKI – acute kidney injury ( previously known as renal failure ).Characterized by a decline in renal excretory function over 
hours or days that can result in failure to maintain fluid , electrolyte
 and acid-base homeostasis ( AKI )

Seen in about 13-22 % % of hospitalized patients AKI has replaced the concept of renal failure Higher incidence and mortality in ICU patients Associated with serious short- and long term complications Acute tubular necrosis ( ATN ) accounts for majority ( 45-70 % ) of cases of AKI Often asymptomatic and only diagnosed by lab tests

Rise in serum creatinine of 26 micromol / L or greater within 48 hrs 50 % or greater rise in serum creatinine known or presumed to have occurred within the past 7 days Fall in urine output to less than 0.5 ml /kg /hour for more than 6 hrs

pre-renalReduced renal perfusion eg 
hypovolemia
haemorrhage
sepsis
3rd spacing of fluids
over diuresus
heart failure
 Renal vasoconstriction eg
hypercalcemia
catecholamines
 Impaired renal autoregulation
NSAIDs
ACE-i / ARB
Cyclosporine
 Hepatorenal syndrome- unexplained and progressive ↑↑ in plasma creatinine in advanced liver dis renal- Acute tubular necrosis
Ischaemic and Toxic Rapidly progressive Gl-Nephritis Interstitial nephritis Vascular diseases
vasculitis
thrombosis
athero/ thromboembolism
dissection Drugs eg aminoglycosides
amphotericin B Contrast induced post renal- Retroperitoneal fibrosis Lymphoma Renal stones Pyonephrosis Blocked catheter Pelvic mass Enlarged prostate Cervical carcinoma Ascending urinary infection incl pyelopnephritis Urinary retention

Admit- Likely stage 3 AKI Obstructed infected kidney suspected No apparent cause of AKI Frail with co-morbidities Risk of Ur Tr obstuction eg
♦ prostate or bladder disease
♦ abd / pelvic cancer
♦ previous known hydronephrosis
♦ recurrent UTIs
♦ anuria
♦ single functioning kidney
♦ neurogenic bladder Sepsis Hypovolemia Suspected AKI related complications eg
♦ pul oedema
♦ uraemic encephalopathy
♦ pericarditis
♦ severe hyperkalemia ( moderate or severe )

discuss- Stage 4-5 CKD Serious secondary cause suspected eg glomerulonephritis , vasculitis Inadequate response to treatment AKI related complications suspected eg
♦ hyperkalemia
♦ hyperphosphataemia
♦ hyponatremia
♦ hypermagnesemia
♦ hypocalcemia
♦ metabolic acidosis
♦ elevated urea nitrogen
♦ vol overload
♦ uraemia
♦ CKD and ESRD Renal transplant

 

 

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