Renal: Acute Kidney Injury: Free MSRA Podcast

✅ MSRA Deep Dive: Acute Kidney Injury (AKI)In this high-yield episode, we tackle acute kidney injury — a condition that frequently complicates hospital admissions and significantly affects patient outcomes. Whether you're revising for the MSRA or managing acutely unwell patients, understanding AKI is essential. This episode follows UK NICE guidelines and breaks down all critical aspects of AKI into clear, structured segments.🧠 Key Learning Points📌 DefinitionAKI is a sudden decline in renal function over hours to days. It results in accumulation of waste products, fluid overload, and electrolyte imbalances.📌 Diagnostic Criteria (KDIGO)AKI is diagnosed if any of the following are present:• ↑ Serum creatinine by ≥26 μmol/L within 48 hrs• ↑ Serum creatinine to ≥1.5× baseline within 7 days• Urine output <0.5 mL/kg/h for >6 hrs📌 Staging (KDIGO)• Stage 1: Creatinine 1.5–1.9× baseline or ↑ ≥26 μmol/L; urine <0.5 mL/kg/h for 6–12 hrs• Stage 2: Creatinine 2–2.9× baseline; urine <0.5 mL/kg/h for ≥12 hrs• Stage 3: Creatinine ≥3× baseline or need for RRT; urine <0.3 mL/kg/h for ≥24 hrs or anuria ≥12 hrs📌 Causes of AKI🔹 Prerenal (90% in community)Hypovolaemia, hypotension, NSAIDs, ACEi, heart failure🔹 Intrinsic renalAcute tubular necrosis, glomerulonephritis, interstitial nephritis🔹 PostrenalObstruction: stones, BPH, bladder tumour, ureteric stricture📌 Risk Factors• Age >65, CKD, diabetes, heart failure, liver disease• Sepsis, dehydration, contrast exposure, nephrotoxic drugs• Cognitive impairment, poor oral intake, recent surgery📌 Symptoms• ↓ Urine output (oliguria), or paradoxical polyuria• Fluid overload: oedema, SOB, raised JVP• Uraemia: nausea, confusion, fatigue• Electrolyte abnormalities (e.g., hyperkalaemia)📌 Investigations• Bloods: Creatinine, urea, FBC, CRP, CK, immunology (if needed)• Urinalysis: Protein, blood, leucocytes, nitrates• Imaging: Renal ultrasound to rule out obstruction• Specialist tests: ANA, anti-GBM, C3/C4, viral serology if glomerular cause suspected📌 Management PrinciplesTreat underlying cause (e.g., fluids for hypovolaemia, stop NSAIDs)Avoid nephrotoxins, review medicationsCorrect fluid/electrolyte imbalancesConsider RRT if:Refractory hyperkalaemiaVolume overload not responding to diureticsSevere acidosisUraemic complicationsPericarditis or encephalopathy📌 When to ReferRefer to nephrology or urology if:• Stage 3 AKI• Underlying CKD stage 4/5• Renal transplant recipient• Obstruction with infection• Glomerulonephritis, vasculitis, or unknown cause• No improvement despite initial management• Complications like pulmonary oedema or hyperkalaemia📌 Prognosis• Mortality: 16% (Stage 1) → 36% (Stage 3)• May progress to CKD or ESRD• Early detection could prevent up to 30% of AKI-related deaths📌 Complications• Hyperkalaemia, metabolic acidosis, fluid overload• Uraemia, pericarditis, encephalopathy• Long-term: CKD, dialysis dependence, increased hospital stay• Psychosocial burden and multi-organ impact📌 Prevention Strategy• Identify high-risk patients• Monitor fluid status, BP, creatinine• Avoid contrast/NSAIDs in at-risk patients• IV fluids before contrast in those who need it🔗 AKI Resources for the MSRA📄 Revision Notes: https://www.passthemsra.com/topic/acute-kidney-injury-revision-notes/💬 Flashcards: https://www.passthemsra.com/topic/acute-kidney-injury-flashcards/🧠 Accordion Q&A: https://www.passthemsra.com/topic/acute-kidney-injury-accordion-qa-notes/📝 Rapid Quiz: https://www.passthemsra.com/topic/acute-kidney-injury-rapid-quiz/🎯 Quiz Hub: https://www.passthemsra.com/quizzes/acute-kidney-injury/📚 Course Page: https://www.passthemsra.com/courses/renal-for-the-msra/🏷️ Hashtags#MSRA #AcuteKidneyInjury #RenalMSRA #MSRARevisionNotes #MSRAFlashcards #MSRAQuiz #MSRAQANotes #PassTheMSRA #FreeMSRA #AKI #UKGuidelines #MSRAQuestionBank