+ causes of acute kidney injury amy livesey. + overview why acute kidney injury? definition recap of...
Post on 18-Dec-2015
214 Views
Preview:
TRANSCRIPT
+
Causes of Acute Kidney InjuryAmy Livesey
+Overview
Why Acute Kidney Injury?
Definition
Recap of types of AKI
Causes of Acute Kidney Injury
How to recognise AKI clinically
Summary
+Why Acute Kidney Injury?
8.10 Acute renal failure
By the end of phase II students should be able to:
Recognise acute renal failure, distinguish is from chronic renal failure and relate the changes to the underlying pathophysiology
Act to prevent the condition as far as possible
Initiate investigation and management for the patient
Discuss the prognosis of acute renal failure
+Why Acute Kidney Injury?
8.10 Acute renal failure Kidney Injury
By the end of phase II students should be able to:
Recognise acute renal failure, distinguish is from chronic renal failure and relate the changes to the underlying pathophysiology
Act to prevent the condition as far as possible
Initiate investigation and management for the patient
Discuss the prognosis of acute renal failure
+Definition
Can anybody think of a succinct definition?
+Definition
Acute Kidney Injury is defined as:
A significant deterioration in renal function, which is potentially reversible, over a period of hours or days.
+DefinitionRenal Association criteria:
Serum creatinine rises by ≥ 26µmol/L within 48 hours or
Serum creatinine rises ≥ 1.5 fold from the reference value, which is known or
presumed to have occurred within one week or
urine output is < 0.5ml/kg/hr for >6 consecutive hours (oliguria)
+
Acute Kidney Injury(acute renal failure)
Hours - weeks
Chronic Kidney Disease
recovery
End stage renal disease (failure)
Months - years
Kidney Disease and Renal Failure
+
Causes ofAcute Kidney Injury
+Causes of AKI
Normal urine output requires:
1. Adequate blood supply to the kidneys
2. Functioning kidneys
3. Unobstructed flow of urine from kidneys, down the ureters, into the bladder and out via the urethra.
+Causes of AKI
1. Pre-renal
2. Intrinsic/ renal
3. Post-renal
+1. Pre-renalI.e. Inadequate blood supply to the kidneys
Inadequate cardiac function
Hypovolaemia
Obstruction of arterial supply Drugs altering renal
haemodynamics NSAIDs ACEi
+2. Intrinsic/ RenalI.e. Damage resulting in impaired kidney function
1. Tubular Acute Tubular Necrosis (‘Muddy brown casts’ in urinalysis)
2. Glomerular Glomerulonephritis
3. Interstitial Interstitial nephritis (usually drug induced e.g NSAIDs, ABX)
4. Vascular Vasculitis, emboli, Malignant HTN, DIC...
5. Infectious Malaria, Legionnaires’ disease, Leptospirosis
6. Complex mechanism (!) Multiple Myeloma
+3. Post-renali.e. obstruction to urinary flow
1. Ureters (e.g Abdominal/pelvic mass compressing ureters, bilateral calculi, retroperitoneal fibrosis).
2. Bladder (e.g Neuropathic bladder, bladder tumour of calculi)
3. Uretha (e.g BPH, blocked catheter, prostate cancer, urethral stricture, trauma, infection)
+How to recognise AKI clinically
General pattern of acute kidney injury:
Increase in K+
Increase in urea
Increased creatinine
Reduced pH
• Low BP• Tachycardia• Reduced urine output• Weight loss• Drugs:
• NSAIDs• ACEI/ ARB• Radio contrast
• Fever
+Hopefully you can now all….
Have an idea of how to define AKD
Know how to tackle answering a question about causes of AKI Pre-renal Renal Post-renal
Be able to recognise AKI clinically
top related