Transcript AKI vs CKD - PeerMedics

Renal disease: AKI vs CKD
Chris Dobson
• What is acute kidney injury (AKI)
• Hyperkalaemia
• What is chronic kidney disease (CKD)
• Case/off
So what is an AKI?
• Significant deterioration in renal function over hours/days
• How would you define that clinically?
• Urea↑ creatinine ↑
• Oliguria?
• Fluid balance?
Say what you see....
RIFLE CRITERIA
In real life...
• RIFLE is complicated
• Urine <0.5ml/kg/hr or creatinine >26umol
• Symptoms:
• Pallor, dehydration, N+V, confusion
• Signs:
• Pallor, rash, dehydration, hypertension, palpable bladder, ↑JVP
Causes of an AKI
• Pre renal:
• hypovalaemia, hypotension, sepsis, renal artery stenosis, burns
• Intrinsic:
• acute tubular necrosis, drugs, vasculitis, autoimmune
• CLANG!
• Post renal:
• tumours, crystals, obstruction
Investigate
• Assess the patient: obstruction, comorbidities, nephrostomy
• Bloods:
• FBC, K+, U+E’s, ABG’s, clotting, cultures, CK
• Bedside:
• urine dip
• Images:
• CXR, KUB
• Other:
• ECG
Management
BOOM
• Depends on the cause..
The sepsis
best manager in the
• Stabilise the patient: shock, hypovalemia, hypotension,
world.
• Stop nephrotoxic drugs
• Furosemide for fluid overload
• Manage hyperkalaemia...
Hyperkalaemia
• what do you know?
• K+ >5.5 mmol
• ECG changes?
• Weakness, fatigue, muscle paralysis, chest pain, palpitations,
Managing Hyperkalaemia
• Calcium gluconate 10ml 10% IV (cardioprotective)
• Calcium resonium 15g/8h
• Salbutamol 5mg nebs
• Insulin+glucose
• Furosemide
CKD
• Kidney damage >3months
• Based on eGFR...
Causes...
• Hypertension
• Diabetes
• Glomerulonephritis
• Pyleonephritis
• BPH
• Myeloma
• Amyloidosis
• Alport syndrome
Presentation
• Usually asymptomatic
• Severe cases can present with anoreixa, N+V, muscle cramps, fatigue,
impotence
• Signs: skin excoriation, pallor, peripheral oedema, restless legs
investigate
• Caution for: AKI, cardiovascular disease, SLE, renal calculi, FH CKD5
• eGFR is best measure
• Rule out UTI, anaemia, heart failure (ECG)
• Any druggy culprits?
Manage
• Lifestyle advice: salt/fluid restriction
• Correct hypertension
• Exclude anaemia/renal osteodystropy
• Furosemide for oedema
• Gabapentin for restless legs
Still the special one?
Case 1
• A 50 year old alcoholic male presents with sepsis secondary to klebsiella
pneumonia. His background includes IHD, previous pneumonia,
hypercholesterolaemia and hypertension. Medications include: furosemide,
enalapril, aspirin, clopidogrel, co-amoxiclav (current) and simvastatin
• He is treated with IV antibiotics and is managed on an ITU setting for 1 week
• On step down to a medical ward routine bloods reveal:
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Sodium 132
Potassium 5.0
Urea 24 (from 8)
Creatinine 390 (from 60)
• Clinically he is mildly dry, with a BP 135/83, HR 90, he is catheterised with a
U/O 35ml/hr
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• How do we manage
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Stop furosemide, enalapril
Push fluids
Monitor urine output
Underlying cause
Case 2
• George is a 72 year old male found collapsed at home on floor of his
bedroom, incontinent of urine and faeces. He complained of significant pain
in his right hip with shortening and rotation. George’s family last had contact
with George 3 days prior to his collapse.
• Assessment:
• On arrival at ED he is confused and combative with a GCS 0f 13
• Initial observations reveal BP 78/60; Pulse 74, RR 32, SPO2 91% (NRB 15L)
• ABG which shows a Potassium of 9.0, pH of 7.23 and a Blood Glucose Level
of 32mmol
• Medical History:
• CCF, Hypertension, Type 2 DM, Osteoarthritis
• Medication History:
• George is taking enlapril for hypertension; spironolactone & metoprolol for
his CCF and celebrex for his osteoarthritis
• His diabetes is diet controlled.
• Hyperkalaemia:
• Calcium gluconate 10% 10ml IV
• Inuslin glucose IV
• Salbutamol nebs
• Calcium resonium IV
• Furosemide IV
So...
• AKI- urine output decreasing; creatinine/urea increasing over hours
• Stop nephrotoxic drugs
• Hyperkalaemia- complication of AKI, treat quickly
• CKD- measured from eGFR, manage underlying cause
End