Medicine Dr. Dana Lecture 1 Acute Kidney Injury (AKI)
|
|
- Gertrude Webb
- 6 years ago
- Views:
Transcription
1 Medicine Dr. Dana Lecture 1 Acute Kidney Injury (AKI) Renal function Kidney has many roles: 1. Excretory function 2. Osmolality regulation 3. Acid base balance 4. BP regulation through salt and water balance 5. Hormone secretion (Erythropoietin, Vit D3) Definition of Acute Kidney Injury (source: acute kidney injury network) Acute usually reversible decline in renal function Rapid time course( < 48 hrs) Reduction of kidney function: A- Rise in serum creatinine, defined by either: 1- absolute increase in serum creatinine of >0.3mg/dl( >26µmol/l) 2- % increase in serum creatinine of > 50% B- Reduction in urine output, defined as < 0.5ml/kg/hr for more than 6 hrs Incidence of AKI* 500 ppm/year UK ( up to 38,000/yr) Incidence of AKI needing dialysis 200 ppm/year Pre renal and acute tubular necrosis (ATN) accounts for 75% of the cases of AKI 7% of all hospital admissions( 65% of intensive care admission) Mortality: 5-10% in uncomplicated AKI 50-70% in AKI secondary to other organ failure( intensive care) > 50% in dialysis requiring AKI 1
2 PRE-RENAL AKI Diagnosing pre-renal AKI Is the patient volume depleted? Is cardiac function good? Is the patient septic? History Examination Investigations Examination : 1- Signs of Hypovolaemia: a. Low BP( and reduced pulse pressure) b. Postural BP drop ( a fall in systolic BP > 10mmHg) c. Sinus tachycardia and postural increase in heart rate ( increase in HR > 10 beat/min) d. Low JVP. e. Cool peripheries and vasoconstriction ( septic patients may be vasodilated) f. Poor urine output. 2- Sings of hypervolaemia( high extracellular fluid): a. Increased circulating volume: - High BP - Elevation of the JVP b. Increased interstitial fluid: - Peripheral or generalized oedema Lab investigation: - Blood tests - Pulmonary oedema (tachypnoea, tachycardia, third heart sound, basal crackles) - Pleural effusion - Ascites - Urine: including urinary Na( low) Case 1 67 yr man IHD Admitted with D&V O/E JVP not seen, BP 100/60 lying, 80/50 standing, pulse 105 bpm Creatinine 5.8 ( mg/dl) x2 IV access Given IV saline Catheterised and started on frusemide Function worsened and transferred to renal unit 2
3 What was the only helpful intervention 1- Inserting a urinary catheter 2- Inserting a CVP line 3- Administering IV fluids 4- Administering diuretics Treatment of pre renal failure DO NOT put in a urinary catheter DO NOT GIVE DIURETICS improving urine volume does not mean an improvement in renal function CVP line rarely needed and certainly not substitute for clinical examination 1. Volume replacement 2. Improve cardiac function in congestive cardiac failure Volume replacement: fluid, blood, plasma expander A- Resuscitate: - Hypotensive and tachycardic - 0.9% Normal saline?how much - be aware of fluid overload (high BP, RR, basal lung crackles and low sato2) - fluid challenge ( trial ml N saline IV in 10min, then re-assess, repeat if necessary) B- Replacement: depends on a- Degree of hypovolaemia b- Ongoing losses c- Whether oligo-anuric d- Cardiovascular status A rough guide ( be aware of elderly and those with poor left ventricular function): - first litre over 2 hours, THEN REASSESS - second litre over 4 hours, THEN REASSESS - third litre over 6 hours, THEN REASSESS *Remember to add insensible loss, if not sure or think you over done it, stop all fluid and reassess the patient C- Maintenance Once euvolaemic, and assume no other losses, match urine out put plus 30mls/hour (insensible loss may be higher if febrile) 3
4 RENAL (INTRINSIC) AKI Diagnosing Intrinsic Renal AKI Has pre-renal and post renal been excluded? 1. History: Drug, Rash, joints, nose bleed, haemoptysis, hearing loss, claudication, IHD, diabetes, fever or night sweat, Recent infection 2. Examination: Oedema, rash, mouth ulcer, hearing loss, uveitis, AF, ischaemic toe, bruits, aortic aneurysm, evidence of scleroderma, prosthetic valve or stigmata of Endocarditis 3. Laboratory investigations: a. Urine including microscopy, Bence Jones protein, protein/creatinine ratio b. Blood nephritic screen ANA, dsdna, ANCA, antigbm, Immunoglobulines protein electrophoresis, Rh-factor, HBV, HCV, HIV, cryoglobulins, blood film, CK, C3,C4, ASOtitre, ESR and CRP 4. US kidneys 5. Renal biopsy Criteria for distinction between pre-renal and intrinsic causes of renal dysfunction Pre renal Intrinsic Urine specific gravity > < Urine osmolality(mosm/kg) > 500 > 350 Urine Na (mmol/l) < 20* > 40 Fractional excretion of Na < 1% > 1%** * Except in diuretics or dopamine ** remains low in contrast nephropathy and myoglobinuria Case 2 What did they do right? 56 years old man Cough, haemoptysis and joint pain O/E JVP +6cm Creatinine 7.5mg/dl( ) on admission IV access, started on IV fluid and diuretics- SOB worsened Transferred to renal unit after 1 week when renal function failed to improve What was done correctly 1. Omission of urine catheter 2. Administered IV fluids and diuretics 3. Transfer to renal unit after 1 week 4
5 Treatment of intrinsic renal AKI GN autoimmune immune suppression/ plasma exchange Infective Bacterial Endocarditis - antibiotics Interstitial nephritis - Stop offending medication - Corticosteroids ATN - In-hospital mortality 19-37%* - Recovery could take up to 6 weeks** - Self correcting (full 60%, some 30%, dialysis 5-10%) - Very severe permanent cortical necrosis POST-RENAL AKI Nature of Obstruction Outside - Tumours, prostate, retroperitoneal fibrosis, cervical Ca Within wall - Tumours, strictures Within lumen - Stones, tumours Diagnosing post renal AKI 1. History: pain, anuria, haematuria, prostatism 2. Examination: palpable bladder, central abdo mass, PR, PV 3. Observation 4. Laboratory investigations - Urine - Blood - Imaging US, CT Treatment of Post renal AKI Obtain drainage of Urine - Bladder catheter per urethra, suprapubic - Retrograde drainage - Antegrade drainage 5
6 Case 3 82 years old man Not passed urine for 20 hrs O/E: large bladder and prostate on PR Creatinine 8.3 USS- dilated bladder Urine catheter inserted, start to pass lots of urine Following day creatinine 4.2 but then over subsequent days rises to 5.1 then 5.8 then 6.4. still passing lots of urine What is the right intervention A- Restrict fluid to reduce urine output B- Give IV normal saline C- Remove catheter D- Investigate for other causes of renal failure Post recovery diuresis Occurs post resolution of AKI - Post relief of obstruction - Post ATN Important to check fluid status - Clinical exam - BP and pulse - Daily weight - Input and output chart Treatment IV fluids, replace electrolyte COMPLICATION OF AKI 64 years old man admitted with: Potassium 7.4 Urea 90 Creatinine 8.5 6
7 What is the first line treatment? A- Insulin and dextrose B- IV calcium C- Ca resonium D- Low potassium diet E- Dialysis Other Complications of AKI Pulmonary oedema Acidosis Uraemia Other electrolyte disturbance such as hyerphosphataemia and hypocalcaemia Who is a risk? Many cases of AKI should never occur in the first place 1- Elderly 2- Pre-existing renal disease 3- Surgery, trauma, sepsis or myoglobinuria 4- Diabetes 5- Volume depletion( Nil By Mouth, bowel obstruction, burn) 6- LV dysfunction 7- Nephrotoxic drugs 8- Cirrhosis (reduce arterial volume) Common nephrotoxins NSAID Diuretics, ACEI, ARB2 especially in volume depleted patient Antibiotics, Aminoglycosides, Vancomycin Amphotericin B Immunosuppressant (ciclosporin, tacroliums) and chemotherapy (Cisplatin) IV contrast 7
8 Reducing risk perioperatively Three principles: 1- Avoid dehydration 2- Avoid nephrotoxins 3- Review clinical status and renal function those at risk Optimize volume status 1- No patient should go to theatre dehydrated 2- Review daily weight, input and output chart 3- Calculate losses especially those NBM (use 0.9% N saline and NOT 5% Dextrose) Optimize blood sugar control in DM ( use sliding scale Catheterize those with prostate disease Avoid surgery if possible immediately after a contrast procedure Stop nephrotoxic drugs 24-48hrs preoperatively Review the patient EARLY postoperatively Have you Have seen the result of K and acted appropriately? Assessed the patient s volume status and treated pulmonary oedema or corrected hypovolaemia? Taken full history and examined patient head to toe? Excluded palpable bladder? Seen the patient s regular drugs? And stopped nephro-toxins? Arranged urgent ultrasound(within 24hr)* Performed urine test and send for microscopy and MSU Checked acid-base status and intervened appropriately? Checked for any previous tests of renal function? Checked Hb, Calcium and Phosphate? Send blood for full nephritic and myeloma screen if you are suspecting intrinsic renal failure? * NCEPOD recommendation/ National Confidential Enquiry in to patient outcome and death. Summary 3 categories of AKI Simple clinical assessment will define which Be aware of life threatening complications and emergency treatment Recognise those at risk 8
ACUTE KIDNEY INJURY A PRIMER FOR PRIMARY CARE PHYSICIANS. Myriam Farah, MD, FRCPC
ACUTE KIDNEY INJURY A PRIMER FOR PRIMARY CARE PHYSICIANS Myriam Farah, MD, FRCPC Clinical Assistant Professor Division of Nephrology, University of British Columbia November 2016 1. How to recognize acute
More informationAcute Kidney Injury (AKI) Undergraduate nurse education
Acute Kidney Injury (AKI) Undergraduate nurse education Year Three Developed Summer 2017 Objectives Understand Acute Kidney Injury and its relevance to patient care. Brief revision of the Anatomy and physiology
More informationNephrology. 3 rd Year Revision Session 06/05/17 Cathal Hannan
Nephrology 3 rd Year Revision Session 06/05/17 Cathal Hannan Aims Acute Kidney Injury-recognition and management Sample OSCE Station Clinically relevant renal physiology Aetiology of Chronic Kidney Disease
More informationAcute Kidney Injury in The Acute Oncology Patient
Acute Kidney Injury in The Acute Oncology Patient Dr Andrew Lewington BSc MEd MD FRCP Consultant Renal Physician/Honorary Senior Lecturer Leeds Teaching Hospitals Definition Definitions and terminology
More informationWEEK. MPharm Programme. Acute Kidney Injury. Alan M. Green MPHM13: Acute Kidney Injury. Slide 1 of 47
MPharm Programme Acute Kidney Injury Alan M. Green 2017 Slide 1 of 47 Overview Renal Function What is it? Why does it matter? What causes it? Who is at risk? What can we (Pharmacists) do? How do you recognise
More informationAcute Kidney Injury in the ED
+ Acute Kidney Injury in the ED + Dr Eric Clark, MD FRCPC University of Ottawa Canada Canadian Association of Emergency Physicians + Outline 1. Diagnostic challenges 2. ED treatment 3. Contrast induced
More informationAcute Kidney Injury shared guidance
Acute Kidney Injury shared guidance Acute Kidney Injury (AKI) Fluid balance assessment (NICE CG 169) Assess the patient s likely fluid and electrolyte needs 1.History previous limited intake, thirst, abnormal
More informationAcute Kidney Injury. I. David Weiner, M.D. Division of Nephrology, Hypertension and Transplantation University of Florida and NF/SGVHS
Acute Kidney Injury I. David Weiner, M.D. Division of Nephrology, Hypertension and Transplantation University of Florida and NF/SGVHS 374-6102 David.Weiner@medicine.ufl.edu www.renallectures.com Concentration
More informationMr PA. Clinical assessment of hydration. Poor urine output Sunken eyes Moistness of mucosa Cool peripheries Reduction in weight Postural hypotension
X Anthony Warrens Mr PA 54 years old Previously well Went to Thailand Developed serious diarrhoea and vomiting two days before coming home 24 hours after return, still unwell GP found: urea 24 mmol/l creatinine
More informationDisorders of the kidney. Urine analysis. Nephrotic and nephritic syndrome.
Disorders of the kidney. Urine analysis. Nephrotic and nephritic syndrome. Azotemia and Urinary Abnormalities Disturbances in urine volume oliguria, anuria, polyuria Abnormalities of urine sediment red
More informationACUTE KIDNEY INJURY FOCUS ON OBSTETRICS DONNA HIGGINS, CLINICAL NURSE EDUCATOR, NORTHERN LINCOLNSHIRE HOSPITALS NHS FOUNDATION TRUST
ACUTE KIDNEY INJURY FOCUS ON OBSTETRICS DONNA HIGGINS, CLINICAL NURSE EDUCATOR, NORTHERN LINCOLNSHIRE HOSPITALS NHS FOUNDATION TRUST AIMS & OBJECTIVES Review the functions of the kidney Identify renal
More informationElevated Serum Creatinine, a simplified approach
Elevated Serum Creatinine, a simplified approach Primary Care Update Creighton University School of Medicine. April 27 th, 2018 Disclosure Slide I have no disclosures and have no conflicts with this presentation.
More informationAcute Renal Failure. Dr Kawa Ahmad
62 Acute Renal Failure Dr Kawa Ahmad Acute Renal Failure It is characterised by an abrupt reduction (usually within a 48- h period) in kidney function. This results in an accumulation of nitrogenous waste
More informationAcute Kidney Injury (AKI)
(Last Updated: 08/22/2018) Created by: Socco, Samantha Acute Kidney Injury (AKI) Thambi, M. (2017). Acute Kidney Injury. Lecture presented at PHAR 503 Lecture in UIC College of Pharmacy, Chicago. AKI This
More informationFluids and electrolytes: the basics
Fluids and electrolytes: the basics This document is based on the handout from the Surgery for Finals course. The notes provided here summarise key aspects, focusing on areas that are popular in clinical
More informationManagement of Nephrotic Syndrome
Management of Nephrotic Syndrome 1. Introduction Incidence 2-4/100,000. Boys > girls 3:2; age of onset 2-6 years 80% of cases in children is due to minimal change (MCD) of which 80% will respond to steroid
More informationFluid assessment, monitoring and therapy for the acute nurse
Fluid assessment, monitoring and therapy for the acute nurse Kelly Wright Lead Nurse for AKI King s College Hospital Aims and objectives Aims and objectives Why do we worry about volume assessment? Completing
More informationAn Introduction to Acute Kidney Injury (AKI) An Education Package for Healthcare Professionals in Medical Directorates
An Introduction to Acute Kidney Injury (AKI) An Education Package for Healthcare Professionals in Medical Directorates STH Acute Kidney Injury (AKI) Project 1 What is Acute Kidney Injury (AKI)? AKI is
More informationAcute Kidney Injury. Eleanor Haskey BSc(hons) RVN VTS(ECC) VPAC A1
Acute Kidney Injury Eleanor Haskey BSc(hons) RVN VTS(ECC) VPAC A1 Anatomy and Physiology The role of the kidneys is to filter the blood through the glomerulus to form filtrate. The filtrate is then reabsorbed
More informationBREAK 11:10-11:
1. Sepsis Tom Heaps 09:30-10:20 2. Oncological Emergencies Clare Pollard 10:20-11:10 ------------------------ BREAK 11:10-11:30 ------------------------ 3. Diabetic Ketoacidosis Tom Heaps 11:30-12:20 4.
More informationThe role of the Nephrologist in Acute Kidney Injury. Rebecca Brown Consultant Nephrologist Royal Liverpool University Hospital
The role of the Nephrologist in Acute Kidney Injury Rebecca Brown Consultant Nephrologist Royal Liverpool University Hospital Overview Impact of AKI Need for change Who needs a Nephrologist Are we making
More informationLiverpool experience of Community AKI care
Liverpool experience of Community AKI care Shahed Ahmed Consultant Nephrologist and Honorary Lecturer Royal Liverpool University Hospital shahed.ahmed@rlbuht.nhs.uk Is AKI really a problem? 100000, deaths
More informationAcute Kidney Injury. APSN JSN CME for Nephrology Trainees May Professor Robert Walker
Acute Kidney Injury APSN JSN CME for Nephrology Trainees May 2017 Professor Robert Walker Kidney International (2017) 91, 1033 1046; http://dx.doi.org/10.1016/ j.kint.2016.09.051 Case for discussion 55year
More informationLondon Strategic Clinical Networks. My AKI. Guidance for patients with, or recovering from, acute kidney injury
London Strategic Clinical Networks My AKI Guidance for patients with, or recovering from, acute kidney injury Supporting the delivery of equitable, high quality AKI care through collaboration www.londonaki.net
More informationBrief summary of the NICE guidelines December 2013
Brief summary of the NICE guidelines December 2013 Intravenous fluid therapy in adults in hospital the relevance to Emergency Department Care Applicable to patients 16 years and older receiving i.v. fluids
More informationAcute Kidney Injury (AKI) Undergraduate nurse education
Acute Kidney Injury (AKI) Undergraduate nurse education Year One Developed Summer 2017 Overview Basic A & P of: Urinary system Kidneys Followed by: Introduction to Acute Kidney Injury Urinary System The
More informationCRRT Fundamentals Pre- and Post- Test. AKI & CRRT Conference 2018
CRRT Fundamentals Pre- and Post- Test AKI & CRRT Conference 2018 Question 1 Which ONE of the following statements regarding solute clearance in CRRT is MOST correct? A. Convective and diffusive solute
More informationRENAL FAILURE IN CHILDREN Dr. Mai Mohamed Elhassan Assistant Professor Jazan University
RENAL FAILURE IN CHILDREN Dr. Mai Mohamed Elhassan Assistant Professor Jazan University OBJECTIVES By the end of this lecture each student should be able to: Define acute & chronic kidney disease(ckd)
More informationDefinition : Stages : ( RIFLE vs. AKIN ) Causes and classification : Pre-renal Renal Post- renal Clinical manifestations and Complication Management
AKI Definition : Stages : ( RIFLE vs. AKIN ) Causes and classification : Pre-renal Renal Post- renal Clinical manifestations and Complication Management and indications for RRT Etiology prerenal causes
More informationCardiorenal and Renocardiac Syndrome
And Renocardiac Syndrome A Vicious Cycle Cardiorenal and Renocardiac Syndrome Type 1 (acute) Acute HF results in acute kidney injury Type 2 Chronic cardiac dysfunction (eg, chronic HF) causes progressive
More informationKIDNEY FAILURE. What causes kidney failure People who are most at risk for kidney failure usually have one or more of the following causes:
KIDNEY FAILURE Your kidneys are a pair of organs located toward your lower back. One kidney is on each side of your spine. They filter your blood and remove toxins from your body. Your kidneys send toxins
More informationDoncaster & Bassetlaw. AKI guidelines for primary care
Doncaster & Bassetlaw AKI guidelines for primary care Contents: FLOW DIAGRAM: MANAGEMENT OF PATIENTS WITH AKI DETECTED IN PRIMARY CARE... 2 FLOW DIAGRAM: MANAGEMENT OF HYPERKALAEMIA.... 3 FLOW DIAGRAM:
More informationMedical therapy of AKI complications. Refik Gökmen AKI Academy 18 October 2014
Medical therapy of AKI complications Refik Gökmen AKI Academy 18 October 2014 Medical therapy of AKI complications Hyperkalaemia Volume status, fluid therapy Acidosis Calcium & phosphate Bleeding risk
More informationLearning Objectives. How big is the problem? ACUTE KIDNEY INJURY
ACUTE KIDNEY INJURY Karen Innocent, DNP, RN, CRNP, ANP-BC, CMSRN Executive Director, Continuing Education Wolters Kluwer Health, Inc May 2016 Orlando FL Learning Objectives Identify the risk factors and
More informationAcute kidney injury. Dr P Sigwadi Paediatric nephrology
Acute kidney injury Dr P Sigwadi Paediatric nephrology Introduction Is common in critically ill patients e.g. post cardiac surgery Occurs when renal function is diminished to a point where body fluid and
More informationDengue Fever & Dengue Shock Syndrome. 07-May-18 PLES / SLCP 1
Dengue Fever & Dengue Shock Syndrome 07-May-18 PLES / SLCP 1 Objectives Early diagnosis Pathophysiology of DHF Proper management How to avoid complications Case 07-May-18 PLES / SLCP 2 Febrile Phase High
More informationAcute Kidney Injury (AKI) In Primary Care Supporting early detection and consistent management
Acute Kidney Injury (AKI) In Primary Care Supporting early detection and consistent management Responding to AKI Warning Stage Test Results for Adults in Primary Care: Best Practice Guidance AKI in Primary
More informationCRRT Fundamentals Pre-Test. AKI & CRRT 2017 Practice Based Learning in CRRT
CRRT Fundamentals Pre-Test AKI & CRRT 2017 Practice Based Learning in CRRT Question 1 A 72-year-old man with HTN presents to the ED with slurred speech, headache and weakness after falling at home. He
More informationMore acute cardiology
Case 1 RC 86, Male More acute cardiology Dr John Chambers Consultant Cardiologist A&E: SOB at rest. No chest pain. Exertional SOB for 6/12. PMHx: HT Rx: Ramipril 5mg od Examination: Afebrile, HR = 105,
More informationSHOCK Susanna Hilda Hutajulu, MD, PhD
SHOCK Susanna Hilda Hutajulu, MD, PhD Div Hematology and Medical Oncology Department of Internal Medicine Universitas Gadjah Mada Yogyakarta Outline Definition Epidemiology Physiology Classes of Shock
More informationWhen and how to start RRT in critically ill patients? Intensive Care Training Program Radboud University Medical Centre Nijmegen
When and how to start RRT in critically ill patients? Intensive Care Training Program Radboud University Medical Centre Nijmegen Case history (1) 64 Hypertension 2004 AVR 2009 Paravalvular leak - dilated
More informationHyponatraemia: confident diagnosis, effective treatment and avoiding disasters. Dr James Ahlquist Endocrinologist Southend Hospital
Hyponatraemia: confident diagnosis, effective treatment and avoiding disasters Dr James Ahlquist Endocrinologist Southend Hospital Hyponatraemia: a common electrolyte disorder Electrolyte disorder Prevalence
More informationDr.Nahid Osman Ahmed 1
1 ILOS By the end of the lecture you should be able to Identify : Functions of the kidney and nephrons Signs and symptoms of AKI Risk factors to AKI Treatment alternatives 2 Acute kidney injury (AKI),
More informationRenal Transporters- pathophysiology of drug - induced renal disorders. Lisa Harris, Pharmacist, John Hunter Hospital, Newcastle, 2015 November
Renal Transporters- pathophysiology of drug - induced renal disorders Lisa Harris, Pharmacist, John Hunter Hospital, Newcastle, 2015 November Renal Failure Up to 25% of acute renal failure is drug induced
More informationChapter 33 Urology & Nephrology Functions of the Kidneys General Mechanisms of Nontraumatic Tissue Problems
1 2 3 4 5 6 7 Chapter 33 Urology & Nephrology Functions of the Kidneys Forming and eliminating Maintaining blood volume with proper balance of water, electrolytes, and ph Retaining key compounds such as
More informationStaging Sepsis for the Emergency Department: Physician
Staging Sepsis for the Emergency Department: Physician Sepsis Continuum 1 Sepsis Continuum SIRS = 2 or more clinical criteria, resulting in Systemic Inflammatory Response Syndrome Sepsis = SIRS + proven/suspected
More informationRicky Bell Renal/ICM Registrar
Ricky Bell Renal/ICM Registrar Objectives When to call renal How to manage the patient with AKI How the manage the patient with CKD (HD/PD) Special AKI situations What do the guidelines say? My referral
More informationSouthern Derbyshire Shared Care Pathology Guidelines. AKI guidelines for primary care
Southern Derbyshire Shared Care Pathology Guidelines AKI guidelines for primary care Contents: Flow Diagram: Recommended response time to AKI warning stage test results for adults in primary care 2 Table
More informationAcute kidney injury. Information for patients Sheffield Teaching Hospitals
Acute kidney injury Information for patients Sheffield Teaching Hospitals page 2 of 12 Acute kidney injury You have been given this leaflet because you have had an episode of acute kidney injury (AKI).
More informationShock Quiz! By Clare Di Bona
Shock Quiz! By Clare Di Bona Test Question What is Mr Burns full legal name? Answer Charles Montgomery Plantagenet Schicklgruber Burns. (Season 22, episode 11) Question 1. What is the definition of shock?
More informationRationale for renal replacement therapy in ICU: indications, approaches and outcomes. Richard Beale
Rationale for renal replacement therapy in ICU: indications, approaches and outcomes Richard Beale RIFLE classification (ADQI group) 2004 Outcome AKIN classification Definition: Abrupt (within 48 hrs)
More informationDIAGNOSIS AND INVESTIGATIONS (Table 13.3) 362 INTENSIVE CARE
362 INTENSIVE CARE the administration of NSAIDs, an ACE inhibitor or an angiotensin II receptor blocker during an episode of renal underperfusion. Dangerous hyperkalaemia, out of proportion to the degree
More informationARNI (Angiotensin Receptor blocker / Neprilysin Inhibitors [Sacubutril/Valsartan]) Heart Failure Medication Initiation and Titration
ARNI (Angiotensin Receptor blocker / Neprilysin Inhibitors [Sacubutril/Valsartan]) Heart Failure Medication and Symptomatic HF despite ACEI/ARB and B-blocker therapy Bilateral renal artery stenosis Moderate/Severe
More informationHyponatraemia- Principles, Investigation and Management. Sirazum Choudhury Biochemistry
Hyponatraemia- Principles, Investigation and Management Sirazum Choudhury Biochemistry Contents Background Investigation Classification Normal Osmolality General management and SIADH Cases Background Relatively
More informationCONTROLLED DOCUMENT. Cirrhosis Care Bundle CATEGORY: Clinical Guidelines. CLASSIFICATION: Clinical. Controlled Document CG201 Number:
Cirrhosis Care Bundle CONTROLLED DOCUMENT CATEGORY: Clinical Guidelines CLASSIFICATION: Clinical Controlled Document CG201 Number: Version Number: 1 Controlled Document Clinical Guidelines Group Sponsor:
More informationHeart-failure or Kidney Failure?
Heart-failure or Kidney Failure? Dr Ajith James Consultant Nephrologist Barts Health and BHRUT Mr AR 65 yrs Case Type 2 DM, IHD-MI 1998, 2003. PCI x 3. CABG 2008, HT CCF with LVEF 30% 2014. NYHA Class
More informationPAEDIATRIC FEBRILE NEUTROPENIA CARE PATHWAY
PAEDIATRIC FEBRILE NEUTROPENIA CARE PATHWAY Purpose: This document is intended as a guide to the investigation and management of children presenting in Salisbury District Hospital with suspected neutropenic
More informationAcute Kidney Injury; get the basics right first!
Acute Kidney Injury; get the basics right first! Dr Christopher Wong, Consultant Nephrologist and General Physician, University Hospital Aintree (UHA), Liverpool, UK Acute kidney injury (AKI) Why a new
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Centre for Clinical Practice SCOPE Clinical guideline title: Intravenous fluid therapy in adults in hospital Quality standard title: Intravenous fluid
More informationSEPSIS SYNDROME
INTRODUCTION Sepsis has been defined as a life threatening condition that arises when the body s response to an infection injures its own tissues and organs. Sepsis may lead to shock, multiple organ failure
More informationCHRONIC KIDNEY DISEASE (CKD)
CHRONIC KIDNEY DISEASE (CKD) CKD implies longstanding (more than 3 months), and usually progressive, impairment in renal function. In many instances, no effective means are available to reverse the primary
More informationIV Fluids. I.V. Fluid Osmolarity Composition 0.9% NaCL (Normal Saline Solution, NSS) Uses/Clinical Considerations
IV Fluids When administering IV fluids, the type and amount of fluid may influence patient outcomes. Make sure to understand the differences between fluid products and their effects. Crystalloids Crystalloid
More informationGUIDELINE FOR THE MANAGEMENT AND PREVENTION OF ACUTE TUMOUR LYSIS SYNDROME IN HAEMATOLOGICAL MALIGNANCIES
GUIDELINE FOR THE MANAGEMENT AND PREVENTION OF ACUTE TUMOUR LYSIS SYNDROME IN HAEMATOLOGICAL MALIGNANCIES Full Title of Guideline: Author (include email and role): Division & Speciality: Scope (Target
More informationA TRICKY PROBLEM. Presenter-Dr Lakshmi PK
A TRICKY PROBLEM Presenter-Dr Lakshmi PK Patient particulars 33 years old Male Resident of Andhra Pradesh Occupation-soldier Chief compliants Headache- 03 days Headache-global,throbbing type Associated
More informationClinical pathological correlations in AKI
Clinical pathological correlations in AKI Dr. Rajasekara chakravarthi Director - Nephrology Star Kidney Center, Star Hospitals Renown clinical services India Introduction AKI is common entity Community
More informationAcute Liver Failure: Supporting Other Organs
Acute Liver Failure: Supporting Other Organs Michael A. Gropper, MD, PhD Professor of Anesthesia and Physiology Director, Critical Care Medicine University of California San Francisco Acute Liver Failure
More informationHyponatraemia. Dr Andy Lewington Consultant Nephrologist/Honorary Clinical Associate Professor Leeds Teaching Hospitals
Hyponatraemia Dr Andy Lewington Consultant Nephrologist/Honorary Clinical Associate Professor Leeds Teaching Hospitals A.J.P.Lewington@leeds.ac.uk Disclosures of Interest Associate Clinical Director NIHR
More informationSIMPLY. Fluids. Dr Will Dooley
SIMPLY. Fluids Dr Will Dooley Plan Maintenance vs Resuscitation Prescribing Common Errors Calculations Drip rates Case 54 yo presents with severe diarrhoea and vomiting. How would you proceed? Assessment
More informationSLCOA National Guidelines
SLCOA National Guidelines Peri - operative Fluid & Electrolyte Management SLCOA National Guidelines Contents List of Contributors 92 Paediatric fasting guidelines for elective procedures 93 Guidelines
More informationNT-proBNP: Evidence-based application in primary care
NT-proBNP: Evidence-based application in primary care Associate Professor Rob Doughty The University of Auckland, Auckland City Hospital, Auckland Heart Group NT-proBNP: Evidence in Primary Care The problem
More informationCONTROLLED DOCUMENT. Diagnosis and Initial Management of Acute Kidney Injury. Controlled Document Number: CG013. Version Number: 2
CONTROLLED DOCUMENT Diagnosis and Initial Management of Acute Kidney Injury CATEGORY: CLASSIFICATION: Controlled Document Number: Version Number: 2 Controlled Document Sponsor: Controlled Document Lead
More informationBedside assessment of fluid status
Bedside assessment of fluid status 2nd AKI Academy October 18 th 2014 David Treacher Guy s & St Thomas NHS Trust Assessing the circulation - the 3 key questions v Is my patient adequately filled? v What
More informationAKI Case study -Vasculitis. Sarah Mackie Renal Practice Development Nurse King s College Hospital - London
AKI Case study -Vasculitis Sarah Mackie Renal Practice Development Nurse King s College Hospital - London What is vasculitis Vasculitis refers to inflammation of the blood vessels, including arteries,
More informationMedical Treatment for acute Decompensated Heart Failure. Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011
Medical Treatment for acute Decompensated Heart Failure Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011 2010 HFSA guidelines for ADHF 2009 focused update of the 2005 American College
More informationASSESSMENT. anatomical assessment but not function. noninvasive. mobile. operator. does not detect all renal scars. nephrocalcinosis.
MCUG GFR is urinary ASSESSMENT Radiological Investigations ultrasound provides advantages anatomical assessment but not function noninvasive mobile disadvantages operator dependent good for does not detect
More informationR2R: Severe sepsis/septic shock. Surat Tongyoo Critical care medicine Siriraj Hospital
R2R: Severe sepsis/septic shock Surat Tongyoo Critical care medicine Siriraj Hospital Diagnostic criteria ACCP/SCCM consensus conference 1991 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
More informationBasic Fluid and Electrolytes
Basic Fluid and Electrolytes Chapter 22 Basic Fluid and Electrolytes Introduction Infants and young children have a greater need for water and are more vulnerable to alterations in fluid and electrolyte
More informationCharles Spencer MD, FRCP Consultant Cardiologist Mid Staffs NHSFT
Charles Spencer MD, FRCP Consultant Cardiologist Mid Staffs NHSFT Key Messages Heart Failure is Common Heart failure is complex Heart Failure is a major issue for the NHS Heart Failure has a worse prognosis
More informationCommunity & In-hospital ACUTE KIDNEY INJURY (AKI) Guidelines
Community & In-hospital ACUTE KIDNEY INJURY (AKI) Guidelines Aug 2017 Page 1 of 18 Contents Page Primary and community care Prevention of acute kidney injury 3 Community AKI guideline 4 AKI Sick Day Guidance
More informationAKI Care Bundles AKI Academy Dr Taryn Pile Consultant Nephrologist and General Physician Guy s and St Thomas Foundation NHS Trust
AKI Care Bundles AKI Academy 2014 Dr Taryn Pile Consultant Nephrologist and General Physician Guy s and St Thomas Foundation NHS Trust Case 1 You are called to the ward on Sunday morning 85 year old female
More informationMAKING SENSE OF IT ALL AUGUST 17
MAKING SENSE OF IT ALL AUGUST 17 @SepsisUK Dr Ron Daniels B.E.M. CEO, UK Sepsis Trust CEO, Global Sepsis Alliance Special Adviser to WHO SCALE AND BURDEN @sepsisuk Dr Ron Daniels B.E.M. CEO, UK Sepsis
More informationAcute kidney injury definition, causes and pathophysiology. Financial Disclosure. Some History Trivia. Key Points. What is AKI
Acute kidney injury definition, causes and pathophysiology Financial Disclosure Current support: Center for Sepsis and Critical Illness Award P50 GM-111152 from the National Institute of General Medical
More informationM2 TEACHING UNDERSTANDING PHARMACOLOGY
M2 TEACHING UNDERSTANDING PHARMACOLOGY USING CVS SYSTEM AS AN EXAMPLE NIGEL FONG 2 JAN 2014 TODAY S OBJECTIVE Pharmacology often seems like an endless list of mechanisms and side effects to memorize. To
More informationDIABETES MELLITUS. Kidney in systemic diseases. Slower the progression: Pathology: Patients with diabetes mellitus are prone to other renal diseases:
Kidney in systemic diseases Dr. Badri Paudel The kidneys may be directly involved in a number of multisystem diseases or secondarily affected by diseases of other organs. Involvement may be at a prerenal,
More informationDengue Case Discussion. When things can go wrong!
Dengue Case Discussion When things can go wrong! What the local experts say! 99.99% of walked in patients who come to hospital with dengue should walk out from hospital! Even those who come in Shock but
More informationIrish Practice Nurses Association Annual Conference Tullamore Court Hotel OCTOBER 6 th 2012
Irish Practice Nurses Association Annual Conference Tullamore Court Hotel OCTOBER 6 th 2012 Susan McKenna Renal Clinical Nurse Specialist Cavan General Hospital Renal patient population ACUTE RENAL FAILURE
More informationD Q. The Renal Handbook. Academic Department of Critical Care. Queen Alexandra Hospital Portsmouth. Renal Group. Queen Alexandra Hospital Portsmouth
D Q Department of Critical Care Renal Handbook 2014 1 Renal Group The Renal Handbook Queen Alexandra Hospital Portsmouth 2 Department of Critical Care Renal Handbook 2014 This renal handbook is designed
More information5/10/2014. Observation, control of blood pressure. Observation, control of blood pressure and risk factors.
Overview The Kidneys Nicola Barlow Clinical Biochemistry Department City Hospital Renal physiology Renal pathophysiology Acute kidney injury Chronic kidney disease Assessing renal function GFR Proteinuria
More informationProfessor Suetonia Palmer
Professor Suetonia Palmer Department of Medicine Nephrologist Christchurch Hospital Christchurch 14:00-14:55 WS #108: The Kidney Test - When To Test and When to Refer ( and When Not To) 15:05-16:00 WS
More informationA Practical Approach to Acute Kidney Injury
A Practical Approach to Acute Kidney Injury Elise Barney, DO Nephrologist Phoenix VA Medical Center Clinical Assistant Professor, Medicine University of Arizona College of Medicine A Tribute to the Kidney!
More informationTop tips for surviving your first on call Dr Maleeha Rizvi
Top tips for surviving your first on call Dr Maleeha Rizvi Specialist Registrar in Cardiology University Hospital Lewisham Overview Practical points The Bleep and prioritising on call Cardiac arrests Prescribing
More informationRenal replacement therapy in Pediatric Acute Kidney Injury
Renal replacement therapy in Pediatric Acute Kidney Injury ASCIM 2014 Dr Adrian Plunkett Consultant Paediatric Intensivist Birmingham Children s Hospital, UK Aims of the presentation Important topic: AKI
More informationKarim Said. 41 year old farmer. Referred from the Uro-surgery Department because of uncontrolled hypertension prior to Lt. partial nephrectomy
Case Presentation Karim Said Cardiology Departement Cairo University 41 year old farmer Referred from the Uro-surgery Department because of uncontrolled hypertension prior to Lt. partial nephrectomy ١
More informationAcute Kidney Injury for the General Surgeon
Acute Kidney Injury for the General Surgeon UCSF Postgraduate Course in General Surgery Maui, HI March 20, 2011 Epidemiology & Definition Pathophysiology Clinical Studies Management Summary Hobart W. Harris,
More informationUpdate in. Acute Kidney Injury. Mark Devonald Consultant Nephrologist. Nottingham AKI Research Group
Update in Acute Kidney Injury Mark Devonald Consultant Nephrologist If you stay awake you might hear about Why AKI is important Some cases to illustrate some specific points A couple of updates on AKI
More informationThe Renal System. Dr Noel Sharkey
The Renal System Dr Noel Sharkey Learning Objectives Function Anatomy Physiology Pharmacology Pathophysiology The Function of the Kidney Excretion - Urea - Metabolites - Drugs Regulation - BP control (RAAS)
More informationPrinted copies of this document may not be up to date, obtain the most recent version from
Children s Acute Transport Service Clinical Guidelines Septic Shock Document Control Information Author Shruti Dholakia L Chigaru Author Position Fellow CATS Consultant Document Owner E. Polke Document
More informationPreventing Acute Kidney Injury
Preventing Acute Kidney Injury Dr Andy Lewington MSc Clin Ed FRCP Consultant Nephrologist/Honorary Clinical Associate Professor Director of Undergraduate Medical Education Leeds Teaching Hospitals A.J.P.Lewington@leeds.ac.uk
More informationM3 Pros Revision 28/4/14 Renal
M3 Pros Revision 28/4/14 Renal Q1. Mr Ravi is a 35- year old construction worker from India with no significant past medical history. He presents with a 3- day history of high fever (Tmax = 39.5), polyarthritis,
More informationThe Excretory System
The Excretory System The excretory system The excretory system includes the skin, lungs and kidneys which all release metabolic wastes from the body. The kidneys, skin and the lungs are the principle organs
More information