[CP]
RRAPID
AKI is a rapid ↓ in kidney fn over hrs – days. Early injury organ failure.
AKI – causes:
Pre-renal: Intrinsic (renal): Post-renal:
Sepsis. GN. Kidney stones.
Toxins – IV contrast. Tubulointerstitial injury. Prostatic hypertrophy.
Hypotension – vomiting, diarrhoea, Acute tubular injury – prolonged pre- Tumours.
diuretics, burns, ACEi, HF. renal, nephrotoxins (gentamicin,
NSAIDs, rhabdomyolysis, Hburia).
Hepatorenal syndrome. Myeloma. Retroperitoneal fibrosis.
RAS. Lupus nephritis.
ANCA vasculitis.
HUS.
TTP.
Rarer forms of AKI e.g. ANCA-assoc vasculitis, lupus nephritis may have systemic Sx – fever, failure
to thrive, rash, jt pains.
If present, check urinalysis – active urinary sediment (blood + prot).
AKI staging – KDIGO:
AKI stage: Serum creatinine: Urine output:
1 SCr ↑ 26 mol/L within 48 hrs < 0.5 ml/kg/hr for 6 consecutive hrs.
OR
SCr ↑ 1.5 – 1.9x from baseline.
2 SCr ↑ 2 – 2.9x from baseline. < 0.5 ml/kg/hr for 12 consecutive hrs.
3 SCr ↑ 354 mol/L < 0.3 ml/kg/hr for 24 consecutive hrs
OR OR
SCr ↑ 3x from baseline Anuria for 12 consecutive hrs.
OR
Initiated on RRT (regardless of stage at initiation
time)
AKI – complications:
HyperK.
Acidaemia.
Pulmonary oedema (iatrogenic).
Pericarditis.
Encephalopathy.
STOP AKI:
1.
2. Sepsis – treat. Identify cause – if not sepsis, toxins,
3. Toxins – avoid. ↓ BP/hypovolaemia, consider
4. Optimise BP/vol status. obstruction or rarer disease.
5. Prevent harm. Treat complications – hyperK,
acidaemia.
Review med doses & fluid Tx.
Red flag sepsis – if pt has any of these criteria, assoc with ↑ morbidity + mortality:
SBP < 90. O2 sats < 91.
Lactate > 2. Unresponsive/responds to voice or
HR > 130. pain.
RR > 25. Purpuric rash.
Sepsis6 – BUFALO:
Blood output + septic screen.
Urine output – monitor hrly, U&Es.
Fluid resuscitation.
ABX IV.
, [CP]
Lactate measurement.
O2 – corrects hypoxia.
RRAPID assessment:
RRAPID
AKI is a rapid ↓ in kidney fn over hrs – days. Early injury organ failure.
AKI – causes:
Pre-renal: Intrinsic (renal): Post-renal:
Sepsis. GN. Kidney stones.
Toxins – IV contrast. Tubulointerstitial injury. Prostatic hypertrophy.
Hypotension – vomiting, diarrhoea, Acute tubular injury – prolonged pre- Tumours.
diuretics, burns, ACEi, HF. renal, nephrotoxins (gentamicin,
NSAIDs, rhabdomyolysis, Hburia).
Hepatorenal syndrome. Myeloma. Retroperitoneal fibrosis.
RAS. Lupus nephritis.
ANCA vasculitis.
HUS.
TTP.
Rarer forms of AKI e.g. ANCA-assoc vasculitis, lupus nephritis may have systemic Sx – fever, failure
to thrive, rash, jt pains.
If present, check urinalysis – active urinary sediment (blood + prot).
AKI staging – KDIGO:
AKI stage: Serum creatinine: Urine output:
1 SCr ↑ 26 mol/L within 48 hrs < 0.5 ml/kg/hr for 6 consecutive hrs.
OR
SCr ↑ 1.5 – 1.9x from baseline.
2 SCr ↑ 2 – 2.9x from baseline. < 0.5 ml/kg/hr for 12 consecutive hrs.
3 SCr ↑ 354 mol/L < 0.3 ml/kg/hr for 24 consecutive hrs
OR OR
SCr ↑ 3x from baseline Anuria for 12 consecutive hrs.
OR
Initiated on RRT (regardless of stage at initiation
time)
AKI – complications:
HyperK.
Acidaemia.
Pulmonary oedema (iatrogenic).
Pericarditis.
Encephalopathy.
STOP AKI:
1.
2. Sepsis – treat. Identify cause – if not sepsis, toxins,
3. Toxins – avoid. ↓ BP/hypovolaemia, consider
4. Optimise BP/vol status. obstruction or rarer disease.
5. Prevent harm. Treat complications – hyperK,
acidaemia.
Review med doses & fluid Tx.
Red flag sepsis – if pt has any of these criteria, assoc with ↑ morbidity + mortality:
SBP < 90. O2 sats < 91.
Lactate > 2. Unresponsive/responds to voice or
HR > 130. pain.
RR > 25. Purpuric rash.
Sepsis6 – BUFALO:
Blood output + septic screen.
Urine output – monitor hrly, U&Es.
Fluid resuscitation.
ABX IV.
, [CP]
Lactate measurement.
O2 – corrects hypoxia.
RRAPID assessment:
