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OK, like guys, can you hear me well? Ok, cool. Thank you, Paul. Um So we'll just wait a few more minutes for a few more people to join. Um and then we'll get started. All right. Um just in the interest of time, I think we should just get started and then people can join us as we go along. Um Nice to see you. Good. Turn out today. Um We're gonna go through some renal emergencies. Um My name is Kie, I'm one of the fy two doctors um, currently working in the black country. Um I haven't actually had a job in Renal. Um, that's my neck rotation um that I'm gonna be going into um, but I've seen quite a lot of renal presentations already in hospital. Um So yeah, we'll go through, go through some cases today and I'll go through some of my experiences as well. What I've seen. Can you guys see the slides? Ok, cool. So the first case um is a, so it's a 65 year old male. Um He's got a background of diabetes, hypertension dyslipidemia and chronic kidney disease and he presents with chest pain, E CG changes show that he's got an acute myocardial infarction. He's taken for an allergic coronary angiogram. Three days later, he's noticed to have developed an elevated serum creatinine oliguria and hyperkalemia. The creatinine. Um, his previous reading was 100 and 51 and now it's gone up to 220 his potassium is 5.8 as well. So what do you think is going on in this case here? Immediate thoughts De Shotta ideas in the chat. So there's a, there's a couple of issues going on here. Um The main issue is the myocardial infarction. So we're, we're assuming that side of it has been treated. But the second issue that's come up as a result of that is the rising creatinine is lack of urine production and the rising um potassium as well. All of these are signs of acute kidney injury. Um So the creatinine, we'll go through some of the criteria for AK I uh in a bit. Um But we can see that the creatinine even without working it out, the creatinine has risen quite a bit. Um And the potassium going up is a sign of um I the kidney is not working as well as well. Yeah. So contrast induced nephro nephropathy is uh another good idea. Um that could also be going on sometimes AK I is caused by uh contrast as well. Um In that case, um you tend to give uh a lot more, well, the general treatment for that is just fluids before um you, you give them contrast. Um a lot of the treatment afterwards tends to be similar. But yeah, that could be going on as well. And do you guys know um what is the pathology of why he's got an A Kr in this condition? So, not just the contrast. So what, what has the MRI done that has made him get an AK I? So the Mr is basically um is a cause of cardiac output going down whenever cardiac output goes down. Um the perfusion to the kidneys also goes down as a result. Um the kidneys are always nearly the, the, the first thing that goes after cardiac output goes down once that happens, that's when AK I happens. So it's the, it's the lack of perfusion to the kidney. That's the pathology here. So we'll go through some of the, the key um diagnostic criteria for an AK I um as we saw. So it's a serum um creatinine um increase and a lack of urine output as well. Um So uh the criteria for diagnosis, it's a bit uh there's a lot of numbers involved here but try and keep it as simple as possible. Um So a rise in creatinine uh more than 26/48 hours or 1.5 times the baseline over 707 days or a urine output, which is less than 0.5 M