class: birds-title <div id="vantajs"></div> <div id="birds-writing"> <h1>AKI</h1> <h3>MBChB Teaching | 2024</h3> </div> <script> VANTA.CLOUDS({ el: "#vantajs", mouseControls: true, touchControls: true, gyroControls: false, minHeight: 200.00, minWidth: 200.00, skycolor: 0x1f7596, speed: 0.50 }); </script> --- # Learning intentions - what is AKI? - two questions to ask in every AKI - four cases ??? See [Nature Primers Review](https://doi.org/10.1038/s41572-021-00284-z). A sudden loss of kidney function, determined on the basis of increased serum creatinine or reduced urine output. AKI = 7 days CKD = 3 months AKDs = in-between ---  ---  --- # Case 1 68F presenting with diarrhoea - HTN, T2DM, smoker, MI, back pain - eGFR 54, uACR 24 mg/mmol - ramipril, furosemide, amolidipine, aspirin, atorvastatin, ibuprofen -- <br><br> - ABP 106/50 - no oedema; JVP +1 -- <br><br> - urea 13 mM, Cr 176 mcM, eGFR 29, Na 132, K 3.7, TCO<sub>2</sub> 17 - Hb 137, alb 30, cCa 2.4 mM - urine: nil ??? Is this acute? Is this pre- / intrinsic / post-renal? What do you think of that blood pressure? What would you do with drugs now? What fluids would you give? What would you do with drugs later? ---  ---  ---  ---  ---  --- # Case 2 35M presenting with painful legs and difficulty walking - drowsy, confused - A&E attendances after recreational drug use -- <br><br> - ABP 124/60, T37.9 - swollen, tense legs - reduced movement in feet; pedal pulses intact; CRT 1s in toes - blisters on front of abdomen / legs -- <br><br> - urea 25 mM, Cr 425 mcM, eGFR 14, Na 124, K 7.2, TCO<sub>2</sub> 22 - Hb 144, WCC 17, plt 570 - alb 33, bili 6, ALT 800, ALP 120, cCa 2.1 mM - urine: black; blood +++ ??? CK 190,000 Is this acute? Pre-renal / intrinsic / post-renal? Further tests? What is diagnosis? Treatment? ---  --- class: black  .RWH_footnote_right[.RWH_footer_style[image credit: Arkana laboratories]] --- # Case 3 62M presenting with sore joints Unwell for 2 months with cough, SOB, painful joints Coughed up tiny flecks of blood yesterday - HTN on rampril, amlodipine, atorvastatin, omeprazole - Cr 98; eGFR > 60, Hb 146 -- <br><br> - looks well; no synovitis; no rashes; afebrile - ABP 150/88; SaO2 96% on air -- <br><br> - urea 8 mM, Cr 140 mcM, eGFR 44, Na 134, K 3.4, TCO<sub>2</sub> 25 - Hb 85, WCC 16, plt 550, CRP 160 - alb 24, cCa 2.6 mM - urine: blood +++, protein ++ ??? Acute or chronic? Pre-renal / intrinsic / post-renal? Further tests? --- class: black, center, middle .white[[ CXR redacted for online slides ]] .white[[ showed alveolar haemorrhage ]] ---  ---  --- class: black  .RWH_footnote_right[.RWH_footer_style[image credit: Arkana laboratories]] --- class: black  .RWH_footnote_right[.RWH_footer_style[image credit: Arkana laboratories]] --- # Case 4 52F with incidental abnormal blood tests - no PMHx, no prior blood tests - bloods before colonscopy (failed bowel screening) -- <br><br> - looks well; ABP 162/92; afebrile -- <br><br> - urea 15 mM, Cr 396 mcM, eGFR 10, Na 139, K 4.1, TCO<sub>2</sub> 22 - Hb 111, WCC 10, plt 208 - alb 40, cCa 2.3 mM, PTH 14 - urine: nil ??? 800 ml residual Is this acute? Pre-renal / instrinsic / post-renal? Next test? ---  --- class: black, center, middle .white[[ images redacted for online slides ]] .white[[ showed hydronephrosis ]] --- # Take-home points - is it acute? - pre-renal / intrinsic / post-renal? - kidney usually the smoke detector rather than the fire - blood and protein on dip | systemic disease | drugs = intrinsic - pulmonary-renal syndrome = GN plus alveolar haemorrhage - IV fluid challenge and review drugs for pre-renal .RWH_footnote_right[.RWH_footer_style[slides at: https://www.kidneyfish.net/talks/]]