Acute Kidney Injury Flashcards
what are the criteria for injury to the kidney in the rifle criteria?
creatinine 2xbaseline
GFR decrease >50%
how can you diagnose acute kidney injury?
azotemia
isosthenuria or inappropriate concentrating ability
hyperkalemia
hyper/hypocalcemia
hyperphosphatemia
acidosis
what are the causes of pre renal or fluid responsive AKI?
hypovolemia
hypotension
prolonged hypotension
cardiac disease
renal artery or vein obstruction
what is a post renal AKI?
blockage of urine flow or abdominal leakage
what are the general AKI etiologies?
infectious agents
ischemia
nephrotoxin
systemic disease
what drugs cause toxic nephropathies?
aminoglycosides
non steroidal anti-inflammatories
how do aminoglycosides cause nephrotoxicity?
necrosis of renal tubular epithelial cells
what is the principle toxicity of non steroidal anti-inflammatory drugs?
nonoliguric ischemic nephrosis
how do non steroidal anti-inflammatories decrease renal perfusion?
inhibition of prostaglandin I2 and E2 synthesis
when does AKI occur after non steroidal anti-inflammatory exposure?
3-5 days after exposure
in whom is lily toxicity observed?
cats
what does lily toxicity cause?
renal tubular necrosis
when will death occur if lily toxicity is not treated?
3-7 days
if treatment is delayed for longer than ____________ from lily ingestion, acute kidney injury will develop
18 hours
what is the toxic component of grape and raisin toxicity?
tartaric acid
what does toxicity from ethylene glycol develop from?
actions of metabolites on tubular epithelium and deposition of calcium oxalate crystals in tubular lumens and interstitium
what signs are seen in 12-24 hours after ethylene glycol ingestion?
severe metabolic acidosis: tachypnea, tachycardia, maybe pulmonary edema and congestion
how can you diagnose ethylene glycol toxicity?
severe metabolic acidosis, high anion gap
serum hyperosmolality
hypocalcemia
azotemia
calcium oxalate monohydrate crystalluria
when is dialysis indicated for ethylene glycol toxicity?
if metabolites already formed
what is pyelonephritis usually secondary to?
ascending lower urinary tract infections
what is the most common organism of pyelonephritis?
E. coli
what can you monitor for an AKI for volume overload?
chemosis, serous nasal discharge, peripheral edema
pulmonary edema
what fluids should you give if a patient is anuric?
replace insensible losses only
how is acute kidney injury diagnosed?
abrupt change in serum creatinine and/or urine output
creatinine increase >0.3 mg/dl or >50% from baseline
what are the causes of pre-renal AKI?
hypovolemia
hypotension
prolonged hypotension
cardiac disease
renal artery or vein obstruction
what are the causes of post-renal AKI?
blockage of urine outflow
abdominal leakage
what are some causes of toxic nephropathies?
drugs
plants
ethylene glycol
food contaminants
vitamin D
how long should you give aminoglycosides for to prevent aminoglycoside nephrotoxicity?
<5-7 days
give once daily
are NSAID kidney lesions usually reversible?
yes: ischemic nature
what dose of ibuprofen causes an AKI in dogs?
200-300 mg/kg
what host factors contribute to lily toxicity?
gastrointestinal absorption
preexisting kidney disease
how can you diagnose lily toxicity?
severe azotemia
normocalcemia
urinalysis changes
what is the estimated toxic dose of grapes?
32 g/kg
11-30 g/kg raisins
what are the most common clinical signs of grape and raisin toxicity?
vomiting
diarrhea
excessive thirst
excessive urination
lethargy
dehydration
when do AKI signs show with ethylene glycol toxicity?
24-72 hours
how can you treat ethylene glycol toxicity?
ethanol
4-MP (fomepizole)
dialysis
what does vitamin D cause?
hypercalcemia
acute tubular damage
what is a significant risk factor for AKI?
volume depletion
between what blood pressures can kidneys autoregulate blood flow?
80-160 mmHg
how quickly should you restore kidney perfusion in an AKI?
2-4 hours
12-24 hours if heart disease
what can you give to convert oliguria to nonoliguria?
loop diuretics
bolus
CRI of furosemide
mannitol if hydrated
fenoldopam
are initial BUN and creatinine values in an AKI prognostic?
no
