The Basics
Anatomy: Which side of the kidney sits slightly higher than the other?
Left
The left kidney is situated a little higher than the right one, because of the liver on the right side of the abdominal cavity, above the right kidney.
Sudden decrease in glomerular filtration rate (GFR) can be classified into what categories?
Pre- Renal
Intra- Renal
Post- Renal
What is a sensitive marker to organ dysfunction?
3 causes of AKI can be categorised as what?
Pre- Renal
Renal/ Intra- Renal
Post Renal
If patient admitted with AKI or reduced fluid intake, what is the most basic management plan you can do?
Fluid Balance
Effective and consistent fluid management is recognised nationally as being an area of weak practice with inadequate fluid balance monitoring and record keeping having been identified as contributing factors to the poor outcome of acutely unwell patients.
Anatomy: What organ connects the Kidneys and the Bladder?
Ureter
The ureters are tubes made of smooth muscle fibres that propel urine from the kidneys to the urinary bladder. Complications can be a possible cause of Post- Renal AKI
Patient admitted with massive GI bleed. The patient is at risk of what type of AKI?
A) Pre- Renal
B) Intra- Renal
C) Post Renal
A) Pre- Renal
Pre-renal injury is due to decreased perfusion to the kidneys secondary to a cause (massive GI bleeding…patient is losing blood volume).
What are the stages of AKI?
(Extra 200 points if you can differentiate the stages)
3 Stages of AKI
AKI stage 1 = creatinine 1.5-1.9x baseline
AKI stage 2 = creatinine 2-2.9 x baseline
AKI stage 3 = creatinine 3x baseline
What defines a diminished Glomerular Filtration Rate (GFR) <60ml/L for more tan 3 months, Persistent low albumin, and Uraemia in more severe forms?
Chronic Kidney Disease
Patient has AKI and hyperkalaemia out of hours. Doctors prescribed Hartman's solution for AKI, what would you suggest for Hyperkalaemia?
50% dextrose IV and 10 units Actrapid
administering IV glucose and insulin to promote the movement of potassium into the cells. If hyperkalemic changes are noted on the electrocardiogram (ECG), IV calcium gluconate may also be administered to raise the cardiac excitation threshold.
Definition: What is Acute Kidney Injury?
Acute deterioration in renal function from a patient's baseline.
Acute kidney injury (AKI) occurs when kidneys suddenly lose their ability to filter waste from the blood, developing within hours or days (National Kidney Foundation, 2024).
Patient diagnosed with AKI. What initial complication can arise?
Hypotension
Can you name 4 clinical signs and symptoms of AKI?
Clinical findings: oliguria/anuria, hypovolaemia signs (dry mucous membranes, tachycardia, hypotension), volume overload signs (hypertension, pulmonary/peripheral oedema), uraemia signs (ecchymosis (bruises), asterixis (flapping tremor), confusion), post-renal obstruction signs (distended bladder).
Pre- Renal AKI is common in most inpatient hospital admission, can you give an example that could cause this?
Sepsis – signs of vasodilation, hot to touch. Hypotensive despite fluids.
Hypovolaemic (and on nephrotoxics)– dehydrated, reduced oral intake. Cool peripherally. Dry mucous membranes. Fluid resuscitate, withhold medications.
May be overloaded – peripheral oedema, hypoxic. Might require offloading
75y/o Male patient admitted with confusion with visual small sediments in the catheter from a care home. Apart from delirium screen, fluid balance and sending urine sample to test for UTI, what else could you do?
- Resolved potential blocked catheter
- hydration
Which of the following causes the majority of UTI’s in hospitalised patients?
Lack of fluid intake (Dehydration)
Which patient is at greatest risk for developing a urinary tract infection (UTI)?
A. A 35 y.o. woman with a fractured wrist
B. A 20 y.o. woman with asthma
C. A 50 y.o. postmenopausal woman
D. A 28 y.o. with angina
C. A 50 y.o. postmenopausal woman
A 75kg patient has a total fluid intake of 1700mls in Nerve Centre. Is this enough?
No
Because...
Ideal fluid requirement of a person is calculated as 30ml x (weight), therefore 30 x 75kg = 2250mls/ day
Patient baseline creatinine is at 90mmol/l. Patient's bloods reviewed and creatinine now at 250mmol/l. What AKI stage is the patient at?
AKI Stage 2 (closely heading to Stage 3)
Urine output: <0.5ml/kg for >12 hours
Patient admitted with AKI due to oesophageal stricture on Ramipril, Metformin, Thiamine, Ibuprofen and Bisoprolol. What medication would you give or not give during your morning meds round?
Not give: Ramipril, Metformin, Ibuprofen
Give: Thiamine (is safe swallow)
Maybe hold off Bisoprolol (depending Haemodynamic changes with dehydration and kidney function)
Name 4 of 6 functions of the Kidneys
(Extra 200 points if can name all 6)
Regulating water volume
Acid/ Base balance
Influences Red Blood Cells production
Controls Blood Pressure
Drug Metabolism and Removal of waste products
Endocrine functions: Vit D production
Can you name 5 risk factors that could cause or contribute to AKI
(Extra 100 points for each other potential causes)
Risk factors: chronic kidney disease, heart failure, liver disease, diabetes, previous AKI, oliguria, cognitive impairment, hypovolaemia, nephrotoxic drugs, iodine-based contrast media, urological obstruction, sepsis, age 65+.
If a 90kg patient is passing a total of 30ml urine per hour, is the patient passing enough hourly urine output?
No
Because...
To calculate ideal hourly urine output is 0.5ml x (weight), therefore 0.5x 90kg = 45mls/hr urine output
Patient complaining of flank pain/ tenderness and chills. What diagnosis would this likely be?
Pyelonephritis
Pyelonephritis is a kidney infection, also known as a kidney infection, and is usually caused by bacteria ascending from the lower urinary tract.
Can you name 4 reasons of 7 when would you escalate to Critical Care Outreach Team?
(Extra 200 points if you can name 3 other potential reasons)
Anuria or Oliguria
Refractory Hyperkalaemia
Refractory Hypotension
Acidosis (Low Bicarb and High Lactate)
Reduced GCS
Fluid Overload
Clinical Concern " Something not right..."