causes of acute kidney injury
DESCRIPTION
Causes of Acute Kidney Injury. Amy 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: - PowerPoint PPT PresentationTRANSCRIPT
+
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 failureBy 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 InjuryBy 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 kidneys2. Functioning kidneys3. Unobstructed flow of
urine from kidneys, down the ureters, into the bladder and out via the urethra.
+Causes of AKI
1. Pre-renal2. Intrinsic/ renal3. 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 function1. Tubular Acute Tubular Necrosis (‘Muddy brown casts’
in urinalysis)2. Glomerular Glomerulonephritis3. Interstitial Interstitial nephritis (usually drug
induced e.g NSAIDs, ABX)4. Vascular Vasculitis, emboli, Malignant HTN, DIC...5. Infectious Malaria, Legionnaires’ disease,
Leptospirosis6. 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 clinicallyGeneral 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