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Podcast - Kidneys on the Edge (Part 1): Understanding AKI
- 2024/11/20
- 再生時間： 9 分
- ポッドキャスト
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サマリー
あらすじ・解説
The video version of this podcast can be found here: · https://youtu.be/k6amIFy84BcThis episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I go through the NICE guideline on acute kidney injury, NG148, focusing on what is relevant to Primary Care only, covering the diagnosis, and investigations, as well as the recommendations on the use of contrast media. In the next episode we will cover the management recommendations by NICE, and the Primary Care flowchart on AKI by Barnsley Hospital NHS Trust and King’s College Hospital NHS Trust, so stay tuned. I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines· Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK· Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The links to the guidance covered in this episode can be found here: Acute kidney injury: prevention, detection and management (NG148):· https://www.nice.org.uk/guidance/ng148The 1-page visual summary on assessing the risk of acute kidney injury in adults having iodine-based contrast media: outpatient, non-urgent inpatient and community settings:· https://www.nice.org.uk/guidance/ng148/resources/visual-summary-pdf-13551376429The algorithm for early identification of acute kidney injury, endorsed by NHS England:· https://www.england.nhs.uk/akiprogramme/aki-algorithm/The Management of acute kidney injury in adults in Primary Care by Barnsley Hospital NHS Trust: · https://best.barnsleyccg.nhs.uk/media/hruaaymn/best-december-2015-barnsley-aki-primary-careguidance-pathway.pdf?form=MG0AV3The Adult Acute Kidney Injury Care Pathway for Primary Care by King’s College Hospital NHS Trust:· https://www.kch.nhs.uk/wp-content/uploads/2023/01/mi-169.2-adult-acute-kidney-injury-care-pathway.pdfA calculator for the National Early Warning Score (NEWS):· https://www.mdcalc.com/calc/1873/national-early-warning-score-newsTranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.Hello and welcome, I am Fernando, a GP in the UK. Today, we will go through the NICE guideline on acute kidney injury focusing on what is relevant in Primary Care only. In this episode, we will cover the diagnosis, and investigations, as well as the recommendations on the use of contrast media. In the next episode we will cover the management recommendations by NICE, and the Primary Care flowchart on AKI by Barnsley Hospital NHS Trust and King’s College Hospital NHS Trust, so stay tuned. Right, let’s jump into it. In order to identify acute kidney injury, we will check serum creatinine and compare it with baseline. AKI is most often seen during episodes of acute illness so we should do this screening in people with acute illness if there is: Pre-existing CKD (or eGFR less than 60)heart failureliver diseasediabeteshistory of acute kidney injuryoliguria (that is, a urine output less than 0.5 ml/kg/hour)neurological or cognitive impairment or disability, which may mean limited access to fluids hypovolaemiause of certain drugs such as NSAIDs, aminoglycosides, ACE inhibitors, ARBs and diuretics within the past week, especially if hypovolaemicuse of iodine-based contrast media within the past weeksymptoms or risk of urological obstruction, sepsisdeteriorating early warning scores andyoung age or age 65 years or over In addition, for children and young people we should also screen for AKI if there is:severe diarrhoea (particularly bloody diarrhoea)symptoms or signs of nephritis (such as oedema or haematuria)haematological malignancy andhypotensionHowever, AKI can also happen in the absence of an acute illness. So, if there is a rise in serum creatinine, we should still consider AKI ...