Acute Kidney Injury

Acute Kidney Injury

3 Types:

1) Pre-renal i.e. renal hypoperfusion

- Dehydration

- Haemorrhage
- Clamps

- “Shock”
- Low cardiac output

2) Intrinsic renal i.e. tubular, glomerular or interstitial injury
 - Acute tubular necrosis
 - Acute glomerulonephritis
 - Acute interstitial nephritis

3) Post-renal

 - Renal tract obstruction
 - Ureteric stone(s)
 - Bladder outflow problems

 - Surgical ties
 - Retroperitoneal disease

Pre-renal:

•Urinary sodium < 20 mmol/l
•Urinary plasma:urea ratio > 10:1

Intrinsic renal:
•Urinary sodium > 20 mmol/l
•Urinary plasma:urea ratio < 10:1

US scan:
Are there two kidneys?
How big are they?
Are they “bright”?
Are they obstructed?

Management of AKI
- Fluid: Match urine output + 500 ml
- Nutrition: Restrict only potassium
- Monitor and treat sepsis
- Reduce gastric acid production
- DVT prophylaxis