ACUTE KIDNEY INJURY Flashcards

1
Q

KEY CONCEPTS

A

AKI CRITERIA
Increased Cr by 26.5 mmol/L within 48 hr

OR

Increased Cr by 1.5x based line within the past 7 days

OR

UOP <0.5 ml/kg/hr for >/6 hr

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2
Q

MANAGEMENT

A
  1. TREAT HYPERKALEMIA

Get stat ECG, Tele, IV Access

MANAGEMENT IF ECG CHANGES
OR K > 6.5:

Calcium chloride 1 g IV
OR
Calcium gluconate 2-3 g IV
AND
Magnesium Sulfate 1-2g IV

2 amp D50 + 10 U insulin
Monitor glucose q 30 min
Repeat k at 60 min

Salbutamol 8 puff

Insert foley

Hypovolemic - IV bolus normal saline, NO diuretic

Hypervolemic - furosemide 40 - 80 mg IV

Sodium polystyrene sulfonate (Keyexalate) 50 g PO

MANAGEMENT OF POTASSIUM AND NO ECG CAHNGES AND K > 5.5 and < 6.5:

2 amp D50 + 10 U insulin
Monitor glucose q 30 min
Repeat k at 60 min

Salbutamol 8 puff

Insert foley

Hypovolemic - IV bolus normal saline, NO diuretic

Hypervolemic - furosemide 40 - 80 mg IV

Sodium polystyrene sulfonate (Keyexalate) 50 g PO

  1. TREAT METABOLIC ACIDOSIS

1 amp NaHC03 IV

  1. DIALYSIS

INDICATIONS: AEIOU

Acid-Base Disturbance: refractory acidemia

Electrolyte Disorder: hyperkalemia, hypercalcemia, tumor lysis

Ingestions: Methanol, Ethylene Glycol, Salicylates, Lithium, Phenobarbitol, Theophylline, Carbamazepine, Valproate, Methotrexate, Dabigatran, Chloral Hexate, Isoniazid

Overload: oliguria, anuria, CHF

Uremia: urea > 50, uremic pericarditis/effusion, encephalopathy / seizures, bleeding diathesis, persistent severe nausea / vomit, fatigue

  1. RULE OUT OBSTRUCTION
    POCUS KUB
  2. HOLD NEPHROTOXINS

SADMANS:
Sulfonylureas
ACEI
Diuretics
Metformin
ARB
NSAIDs
SGLT2i

  1. SPECIFIC TREATMENT

PRERENAL
Optimize Volume status with IV FLuids +/- pressors

INTRINSIC RENAL
Stop Causative Agents
Treat Infection

POSTRENAL
Remove obstruction
Insert Foley Catheter
Consult urology or interventional radiology if stent or nephrostomy is needed

  1. INVESTIGATIONS
    U/A
    Urine Clx
    Urine Microscopy
    Urine Electrolytes
    +/-Urine Sediment
    Urine Osmolality
    FENa: <1% = pre-renal vs. >2% = ATN
    FEUrea (patients on diuretics)
    Urine R+M: 3+ Protein - nephrotic syndrome?
    +blood but no RBCs - myglobunuria
    Urine Eosinophils: >1% a/w AIN
    Renal Ultrasound: hydronephrosis
  2. CONSULT NEPHROLOGY
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3
Q

DOCUMENTATION

A

HISTORY: ASK ABOUT
Decreased PO intake
Polyurea vs. Oliguria
Diarrhea
Abdominal Pain
Flank Pain

Screen for Uremia:
nausea
Vomiting
drowsiness
fatigue
confusion

Recent use of IV contrast DYE

REVIEW MEDICTIONS:

SADMANS
Sulfonylureas
ACEI
Diuretics
Metformin
ARB
NSAIDs
SGLT2i

PHYSICAL EXAM

Orthostatics
Volume Status - evaluate for signs of volume depletion

CVS: S1 / S2 / S3, JVP, HJR
Lungs: crackles
Skin / Skin: Purpura, rash - autoimmune AKI

POCUS:
Cardiac
KUB - check for enlarged bladder and hydronephrosis

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4
Q

DDx PRERENAL

A

Decreased Intravascular Volume:
Hypovolemia (GI losses, bleeding, diuretics, insensible losses)
Decreased Cardiac Contractility
Cirrhosis
Systemic Vasodilation (sepsis)
Nephrotic Syndrome

Drugs (Renal Vasoconstriction):
NSAIDs
ACEi/ARB
Contrast
Calcineurin Inhib
HRS
Hyper Ca

Structural (Large Vessel):
RAS
Vasculitis
Dissection

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5
Q

DDx INTRINSIC

A

Renal-Tubulointerstitial:
Acute Tubular Necrosis (ATN)
Acute Interstitial Nephritis (AIN)

Renal-Vascular Disease

Renal Glomerular

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6
Q

DDx POST RENAL

A

Bladder Neck Obstruction:
BPH
Prostate CA
Neurogenic Bladder
Obstructing Clot

Drugs:
Antihistamines
Anticholinergics
TCAs

Ureteral Obstruction:
Nephrolithiasis
Malignancy

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7
Q

DDx FLUID RETENTIVE STATES

A

Dependent Edema
DVT
Hypoprotenemia
Liver Failure / Cirrhosis
Portal Vein Thrombosis
Renal Failure
Nephrotic Syndrome
CHF

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