Acute Kidney Injury 6

Question 1

What are the key principles for preventing AKI?

Answer 1

Early recognition of renal dysfunction and avoiding nephrotoxins.

Question 2

What are the mainstays of AKI treatment?

Answer 2

Restore fluid balance, correct metabolic/electrolyte derangements, provide nutritional support, and limit further renal injury.

Question 3

When is renal replacement therapy (RRT) indicated in AKI?

Answer 3

When conservative therapy fails, or fluid overload exceeds 10–15% of body weight.

Question 4

What is the first-line fluid for volume resuscitation in AKI?

Answer 4

Isotonic crystalloids (e.g., normal saline or lactated Ringer’s).

Question 5

Why are colloids avoided in AKI resuscitation?

Answer 5

They are associated with adverse effects, such as increased risk of AKI and need for RRT.

Question 6

What is the recommended fluid bolus dosage for children in AKI?

Answer 6

10–20 mL/kg IV/IO.

Question 7

What are the urine output thresholds for oliguria in children?

Answer 7

<1.0 mL/kg/h in infants and <0.5 mL/kg/h in children.

Question 8

When should RRT be initiated based on fluid overload?

Answer 8

When fluid overload exceeds 10–15% of body weight.

Question 9

How should insensible losses be replaced in AKI?

Answer 9

400 mL/m²/day, adjusted for fever or mechanical ventilation.

Question 10

What is the role of diuretics in AKI?

Answer 10

Not for prevention but can manage volume overload or convert oliguric AKI to nonoliguric AKI.

Question 11

What is the recommended dosage for furosemide in AKI?

Answer 11

2–5 mg/kg/dose or 0.1–0.3 mg/kg/h as a continuous infusion.

Question 12

What is a major risk of multiple ineffective doses of furosemide?

Answer 12

Ototoxicity.

Question 13

Are ‘renal-dose’ dopamine infusions effective in AKI prevention?

Answer 13

No, they are not effective and can cause significant side effects.

Question 14

Which vasoactive agent is preferred over dopamine in vasomotor shock?

Answer 14

Norepinephrine.

Question 15

What is fenoldopam and its potential role in AKI?

Answer 15

A selective dopamine-1 receptor agonist that may reduce RRT need in adults; evidence in pediatrics is limited.

Question 16

When is theophylline used in AKI prevention?

Answer 16

In neonates with severe perinatal asphyxia at high risk for AKI.

Question 17

Which agents are not recommended for AKI prevention or treatment?

Answer 17

Nesiritide, atrial natriuretic peptide, IGF-1, and N-acetylcysteine (except for contrast-induced AKI).

Question 18

Why is fluid overload dangerous in AKI?

Answer 18

It correlates with increased mortality and requires RRT when severe.

Question 19

Is the Holliday-Segar method appropriate for fluid maintenance in AKI?

Answer 19

No, precise replacement of insensible and ongoing losses is required.

Question 20

What parameters should be monitored daily in AKI?

Answer 20

Inputs, outputs, and weight.

Question 21

Why is bladder catheterization helpful in AKI management?

Answer 21

It ensures accurate measurement of urine output and confirms oligoanuria.

Question 22

What are the fluid goals after resuscitation in AKI?

Answer 22

Avoid fluid overload and replace remaining deficits over 24–48 hours.

Question 23

What fluids are recommended for post-obstructive diuresis?

Answer 23

0.45% saline at a rate slower than urine output.

Question 24

What are the risks of excessive fluid resuscitation in intrinsic AKI?

Answer 24

It can lead to worsening volume overload and metabolic derangements.

Question 25

How does early identification of nephrotoxins impact AKI outcomes?

Answer 25

It helps prevent further renal injury and reduces mortality risk.