quentin oury (fy1). several!! new nice guidelines due 2014: a rise in serum creatinine (of 26 μ...
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![Page 1: Quentin Oury (FY1). Several!! New Nice guidelines due 2014: a rise in serum creatinine (of 26 μ mol/l or greater within 48 hours) a 50% or greater](https://reader036.vdocuments.pub/reader036/viewer/2022062715/56649d8c5503460f94a74142/html5/thumbnails/1.jpg)
ACUTE KIDNEY INJURYQuentin Oury (FY1)
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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 eGFR in children and young people.
Put simply : Rise in serum creatinine over hours/days/weeks
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Risk factors
Age CKD HF Diabetes Surgery Drugs- CANDA Cognitive/neuro impairment
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Causes
1) Pre-renal: Hypovolaemia: sepsis, CCF, D+V, NSAID/ACEi,
RAS
2) Renal: ATN due to ischaemia/nephrotoxins
(drugs/contrast/myeloma/rhabdo) Gomerulonephritis, vasculitis
3) Post-renal: Obstruction
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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)
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Examination
General Fluid status: BP, skin turgor, mucous
membranes, JVP, oedema (peripheral/pulmonary), urine output
Abdominal (in exams) Palpable bladder?
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Investigations
Bedside: Urine dipstick, urine input/output, daily weights/fluid monitoring ABG/VBG ECG
Bloods FBC and regular tests inc cultures “U+E’s” : CREATININE Renal screen: myeloma, vasculitis, rhabdo
Imaging CXR USKUB
Special Urine PCR CT KUB Renal biopsy
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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
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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
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Complications (cont)
Acidosis Sodium bicarb IV Dialysis
Pulmonary Oedema Sit up O2 Furosemide
Uraemia
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Indications for dialysis
1. Hyperkalaemia (refractory)2. Severe acidosis (refractory)3. Severe pulmonary oedema4. Uraemic encephalopathy
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Key points
Causes: pre-, renal and post- CANDA Treatment: the cause Manage: the complications (& be aware)
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Questions?