Tasty Morsels of EM 116 – #FRCEM Acute Kidney Injury

5 Aug

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here.

From NICE 2013

What are some risk factors for AKI?

by no means exhaustive

  • CKD
  • heart failure
  • liver disease
  • DM
  • history of AKI
  • reduced urine output
  • nephrotoxic drugs and contrast
  • sepsis
  • age>65

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how is it graded?

  • NICE mentions the RIFLE, AKIN and KDIGO systems without adhering to one
  • it does give these criteria
    • inc creatinine by 26 in 48 hrs
    • 50% rise in creatinine in 7 days
    • <0.5ml/kg/hr urine for 6 hrs for adults and 8 hrs for kids
    • 25% reduction in eGFR in 7 days

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how is it investigated?

  • most of this is clinically guided
  • they make specific recommendations on ultrasound
    • within 24 hrs if no obvious cause found clinically
    • within 6 hrs if obstructed infection suspected (eg a stone and sepsis)

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how is it treated?

  • treat cause of course
  • some specific comments on diuretics
    • considered in fluid overload awaiting dialysis
    • considered in fluid overload while renal function recovering

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what are the RIFLE criteria?

because no chance i’m remembering more than one

click for source

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