Acute Kidney Injury 6 Flashcards
What are the key principles for preventing AKI?
Early recognition of renal dysfunction and avoiding nephrotoxins.
What are the mainstays of AKI treatment?
Restore fluid balance, correct metabolic/electrolyte derangements, provide nutritional support, and limit further renal injury.
When is renal replacement therapy (RRT) indicated in AKI?
When conservative therapy fails, or fluid overload exceeds 10–15% of body weight.
What is the first-line fluid for volume resuscitation in AKI?
Isotonic crystalloids (e.g., normal saline or lactated Ringer’s).
Why are colloids avoided in AKI resuscitation?
They are associated with adverse effects, such as increased risk of AKI and need for RRT.
What is the recommended fluid bolus dosage for children in AKI?
10–20 mL/kg IV/IO.
What are the urine output thresholds for oliguria in children?
<1.0 mL/kg/h in infants and <0.5 mL/kg/h in children.
When should RRT be initiated based on fluid overload?
When fluid overload exceeds 10–15% of body weight.
How should insensible losses be replaced in AKI?
400 mL/m²/day, adjusted for fever or mechanical ventilation.
What is the role of diuretics in AKI?
Not for prevention but can manage volume overload or convert oliguric AKI to nonoliguric AKI.
What is the recommended dosage for furosemide in AKI?
2–5 mg/kg/dose or 0.1–0.3 mg/kg/h as a continuous infusion.
What is a major risk of multiple ineffective doses of furosemide?
Ototoxicity.
Are ‘renal-dose’ dopamine infusions effective in AKI prevention?
No, they are not effective and can cause significant side effects.
Which vasoactive agent is preferred over dopamine in vasomotor shock?
Norepinephrine.
What is fenoldopam and its potential role in AKI?
A selective dopamine-1 receptor agonist that may reduce RRT need in adults; evidence in pediatrics is limited.
When is theophylline used in AKI prevention?
In neonates with severe perinatal asphyxia at high risk for AKI.
Which agents are not recommended for AKI prevention or treatment?
Nesiritide, atrial natriuretic peptide, IGF-1, and N-acetylcysteine (except for contrast-induced AKI).
Why is fluid overload dangerous in AKI?
It correlates with increased mortality and requires RRT when severe.
Is the Holliday-Segar method appropriate for fluid maintenance in AKI?
No, precise replacement of insensible and ongoing losses is required.
What parameters should be monitored daily in AKI?
Inputs, outputs, and weight.
Why is bladder catheterization helpful in AKI management?
It ensures accurate measurement of urine output and confirms oligoanuria.
What are the fluid goals after resuscitation in AKI?
Avoid fluid overload and replace remaining deficits over 24–48 hours.
What fluids are recommended for post-obstructive diuresis?
0.45% saline at a rate slower than urine output.
What are the risks of excessive fluid resuscitation in intrinsic AKI?
It can lead to worsening volume overload and metabolic derangements.
How does early identification of nephrotoxins impact AKI outcomes?
It helps prevent further renal injury and reduces mortality risk.
