Acute Kidney Injury

Question 1

AKI initiates what?

Answer 1

inflammatory response, vascular response, and cell death

Question 2

Why does AKI ischemic injury occur?

Answer 2

• Related to volume depletion and decreased perfusion
• Toxic injury from chemicals
• Sepsis

Question 3

3 Classifications of AKI

Answer 3

1. Prerenal
2. Intrarenal
3. Postrenal

Question 4

Prerenal AKI cause

Answer 4

Inadequate Perfusion

-Hypotension, hypovolemia, sepsis, inadequate CO, renal vasoconstriction, or renal artery stenosis

Question 5

Prerenal AKI features

Answer 5

Decreased GFR due to low glomerular filtration pressure

Failure to restore blood volume, blood pressure, and oxygen delivery can cause ischemic cell injury and necrosis

Question 6

Intrarenal AKI causes

Answer 6

Most common cause: Acute Tubular Necrosis (ATN)

-related to prerenal AKI, nephrotoxic agents, acute glomerulonephritis, and vascular disease

Question 7

How does a Prerenal AKI turn into an Intrarenal AKI?

Answer 7

-Hypotension and hypovolemia cause ischemia and inflammatory response in kidney

Question 8

Intrarenal AKI: Nephrotoxic Acute Tubular Necrosis Causes

Answer 8

• Antibiotics (aminoglycosides)
• Heavy Metals
• Contrast Dye

-Rhabdomyolysis
(drug OD)

-Crush injuries

Question 9

Postrenal AKI

Answer 9

A rare condition that usually occurs with urinary tract obstruction

• Bladder outlet obstruction
• Prostatic hyperplasia
• Bilateral ureteral obstruction
• Tumor
• Neurogenic bladder

Question 10

Acute Kidney Injury usually occurs within

Answer 10

Hours

Question 11

Acute Kidney Injury Labs look like?

Answer 11

Decreased
GFR
UOP (oliguria)
BUN

Elevated
Creatinine

ALL MAY BE REVERSIBLE

Question 12

Clinical Manifestations of AKI

Answer 12

Oliguria (<400 mL/24hr)

-Begins 1 day after hypotensive event & lasts 1-3 weeks

Question 13

Goal of treatment in AKI is to?

Answer 13

stabilize patient until kidney function is returned

Question 14

Management of AKI

Answer 14

Correct Fluid Imbalance (esp. hyperkalemia)

Question 15

Correcting Fluid imbalance and hyperkalemia in AKI

Answer 15

• Lasix to try to push kidneys to function and remove K+
• Dextrose and insulin to help move K+ back into cells
• Binders (move K+ through GI)
  1. Sodium polystyrene sulfonate (Kayexelate)
  2. Patiromer (veltassa)
  3. Sodium zirconium (Lokelma)
• Correct Acid Base balance (sodium bicarb)
• Manage BP
• Avoid drugs that a nephrotoxic