Renal Failure

Renal Failure

Acute kidney injury (AKI)


Pathology:                Rapid deterioration of renal function defined by a creatinine rise ≥ 26.4µmol/l within a 48 hour period or a urine output <0.5 ml/kg/hour sustained > 6 hours

Aetiology:            Pre-Renal: Hypovolaemia: CCF, Liver cirrhosis, renal artery stenosis, blood loss

Renal: Acute tubular necrosis, Acute glomerulonephritis, Interstitial nephritis, Vasculitis

Post-Renal: Blocked catheter, enlarged prostate, retroperitoneal fibrosis

Symptoms:               Oliguria, Malaise, lethargy, confusion, nausea, seizure, pruritus, purpura, breathlessness, pericarditis

Signs:                          Reduced urine output, rash, peripheral oedema, arrhythmias, signs of heart failure

Investigations:      Bloods: FBC, U&E, blood film, blood cultures

                                        ABG: Metabolic acidosis

                                        ECG: Assess for underlying pathology

                                               MSU: Urine dipstick

                                               Imaging:  Ultrasound urinary tract to exclude obstruction                                                                       Biopsy: if no obvious cause located – renal vasculitis

Treatment:              Medical: Establish and treat underlying cause for AKI, Fluid resuscitation, Catheter insertion, Stop nephrotoxic drugs , may require dialysis.

Complications:      Hyperkalaemia, fluid overload, uraemia and a high anion gap metabolic acidosis

Prognosis:               50-60% of patients admitted to ITU have AKI.                                           Significant increase in length of hospital stay and increased mortality.                      Majority make good recovery; those with concurrent CKD have a poor prognosis








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