ACUTE KIDNEY INJURY

Acute renal failure (ARF) is a common and serious problem in clinical medicine. It is characterised by an abrupt reduction (usually within a 48-h period) in kidney function. This results in an accumulation of nitrogenous waste products and other toxins. Many patients become oliguric (low urine output) with subsequent salt and water retention

1. ACUTE KIDNEY INJURY – CASE DISCUSSIONS Dr. S P Srinivas Nayak Assistant Professor, SUCP, Hyderbad

2. Acute renal failure Acute renal failure (ARF) is a common and serious problem in clinical medicine. It is characterised by an abrupt reduction (usually within a 48-h period) in kidney function. This results in an accumulation of nitrogenous waste products and other toxins. Many patients become oliguric (low urine output) with subsequent salt and water retention

3. DIAGNOSIS The diagnostic criteria for AKI is based on an increase in serum creatinine or the presence of oliguria . Criteria have recently been introduced for the definition and staging of the condition; the acronym RIFLE is used (Risk, Injury, Failure, Loss and End-stage renal disease (ESRD)) , which is now becoming established in clinical practice.

4. Clinical presentations uraemia , overload Hyperkalemia Acidosis Hypocalcemia Hyperphosphatemia Infection Pnemonic : AEIOU

5. MANAGEMENT IDENTIFY CAUSE AND WITHDRAW OPTIMISE RENAL PERFUSION MAINTAIN DIURESIS SYMPTOMATIC TREATMENT FOR a, e, I, o, u RRT- DIALYSIS

6. CASE STUDY -1 Mrs J a 60-year-old widow, had long-standing hypertension that was unsatisfactorily controlled on a variety of agents. Her drug therapy included furosemide 40 mg once a day, amlodipine 10 mg daily and a salt restricted diet. Following a routine review of her therapy, ramipril 2.5 mg once daily was added to her treatment regimen in an attempt to improve blood pressure control . Mrs J was recently diagnosed with gastroenteritis. A week after her diagnosis she presented to her local hospital emergency unit, with ongoing diarrhoea . Her BP was found to be 100/60 mmHg and serum biochemistry revealed creatinine levels of 225 mmol /L (50–120 μmol /L, Na+ 125 mmol /L (135–145 mmol /l) and K+ 5.2 mmol /L (3.5–5.0 mmol /L).

7. QUESTIONS WHAT IS THE CAUSE OF HER PROBLEM? HOW WOULD YOU TREAT her?

8. ANSWERs There may be 3 reasons for her AKD ACEI HYPOVOLEMIA – DIURETIC AND DIARRHOEA HYPONATREMIA proper investigation done, rehydrated, renal perfusion should be maintained and treat as per symptoms.