(A&E) (Peri-op & Anaesthesia)

Overview

• Acute decline in kidney function, leading to dysregulation of fluid balance and electrolytes, and the retention of nitrogenous waste products
• Risk Factors → age >65 yrs, history of CKD/HF/Liver Disease/Diabetes, Multiple Myeloma, Contrast administration, NSAIDs, ACEi’s or ARBs, Diuretics
• Prerenal → any condition that leads to decreased renal perfusion (60%) (LOW URINARY SODIUM)
• Intrinsic → any condition that leads to severe direct kidney damage (35%) (HIGH URINARY SODIUM)
• Postrenal → any condition that results in bilateral obstruction of urinary flow from renal pelvis to urethra (5%)
• Amboss Overview
• Staging of AKI

Making Diagnosis

Clinical Features:

• Decreased Urine Output → oliguria (reduced urine output) or anuria (complete absence of urine output)
• Signs of Volume Depletion (prerenal AKI) → hypotension, tachycardia, reduced skin turger, orthostatic hypotension, thirsty
• Signs of Fluid Overload (Na+ and H2O retention) → peripheral or pulmonary oedema, hypertension, HF, SOB
• Signs of Uraemia (failure of kidneys to excrete) → anorexia, nausea, encephalopathy, asterixis, pericarditis
• Signs of Renal Obstruction (postrenal AKI) → distended bladder (suprapubic distension), incomplete voiding (LUTS), pain over bladder or flanks