AKI

Question 1

Signs and symptoms of AKI

Answer 1

• Reduced urine output
• Urine colour change- monitor colour change
• Nausea
• Vomiting
• Dehydration
• Thirst
• Confusion
• Drowsiness

Question 2

AKI risk factors

Answer 2

• > 75 years
• Chronic kidney disease
• Previous AKI
• Diabetes
• HF
• Vascular disease
• Liver disease
• Cognitive impairment
• Cancer
• Nephrotoxic meds
• Meds that cause hypoperfusion

Question 3

What drugs induce AKI

Answer 3

NSAID
diuretic
ACEI
antihypertensives- CCB, BB

Question 4

What to consider when monitoring drugs in AKI

Answer 4

• Withhold NSAID, Diuretic, antihypertensives, ACEI
• Amend patient doses according to renal function
• Is there any other meds which are worsening AKI
• Eliminate causative factors
• Eliminate contributory factors
• Avoid inappropriate combos
• Reduce ADR
• Ensure all meds clinically appropriate
• Look for suitable alternatives
• Monitor duration
• Check blood drug concs
• Think about reintroducing stopped meds
• Communicate with patient and primary care team

Question 5

What to consider when monitoring drugs in AKI

Answer 5

• Withhold NSAID, Diuretic, antihypertensives, ACEI
• Amend patient doses according to renal function
• Is there any other meds which are worsening AKI
• Eliminate causative factors
• Eliminate contributory factors
• Avoid inappropriate combos
• Reduce ADR
• Ensure all meds clinically appropriate
• Look for suitable alternatives
• Monitor duration
• Check blood drug concs
• Think about reintroducing stopped meds
• Communicate with patient and primary care team
  Temporarily or permanently withdrawing medicines that affect kidney haemodynamics;
  Stopping nephrotoxic medicines that could have caused the AKI and ensuring that other nephrotoxic treatments are not started;
  Reviewing the side effect profile of all medicines;
  Ensuring a medicine, and its dose, is appropriate for use by patients with reduced renal function.

Question 6

When to refer to specialist in AKI

Answer 6

With stage 3 AKI
With indications for renal replacement therapy
In whom an intrinsic cause of AKI is suspected
Who are not improving despite actions to correct pre-renal causes of AKI

Question 7

What are the intrinsic causes for AKI

Answer 7

• Prolonged prerenal AKI
• Hypovolaemia and hypotension exacerbating meds
• Meds that harm kidneys in acute illness
• Toxins
• Kidney disease= glomerulonephritis, tubulointerstitial nephritis
• Systemic disease processes= myeloma, vasculitis, lupus

Question 8

What are the pre-renal causes for AKI

Answer 8

o	Sepsis
o	Increased fluid loss
o	Dehydration risk
o	Reduced CO
o	HF 
gastrointestinal bleeding, sepsis, cardiac and liver failure, dehydration, burns, hypovolaemia, reduced blood pressure

Question 9

What are the post-renal causes for AKI

Answer 9

benign prostatic hypertrophy, prostate cancer, retroperitoneal fibrosis, renal calculi

Question 10

Managing AKI

Answer 10

Identify and treat underlying cause
pre-renal AKI= circulating blood volume should be restored and blood pressure managed
intrinsic AKI= should be referred to a nephrologist for investigation and management.
Post-renal AKI= ultrasound and patients suffering from the condition are often referred to a urologist
Manage fluid balance- IVF
If fluid overload- loop diuretic
Review medication
advise patient on medication