AKI

Question 1

How is an AKI characterised?

Answer 1

A rapid rise in creatinine or development of oliguria/anuria.

Question 2

What are the prerenal causes of an AKI?

Answer 2

1. hypovolaemia - diarrhoea, vomiting, haemorrhage, burns
2. heart failure
3. renal artery stenosis
4. NSAIDs/ACEi/ARB

Question 3

What are the renal causes of an AKI?

Answer 3

1. Haemolytic uraemic syndrome
2. glomerulonephritis
3. aminoglycosides
4. SLE

Question 4

What are the postrenal causes of an AKI?

Answer 4

1. posterior urethral valves
2. renal stones
3. blocked catheter

Question 5

What are the clinical features of an AKI?

Answer 5

Non specifically unwell, passing little or no urine.

Question 6

How is an AKI investigated?

Answer 6

1. detailed history and examination
2. increased urea and creatinine
3. hyperkalaemia, metabolic acidosis
4. hyperphosphatemia, hypocalcaemia
5. urinalysis for casts
6. ANA, ANCA
7. USS suspecting renal artery stenosis or post renal cause
8. ECG for hyperkalaemia

Question 7

What is the management of an AKI?

Answer 7

1. treat shock and dehydration
2. fluids if urine plasma osmolality ratio is greater than 5
3. Furosemide if urine plasma osmolality ratio is less than 5
4. monitor blood pressure and fluid balance
5. consider renal replacement therapy as soon as fluid overload occurs