Acute Kidney Injury Flashcards

1
Q

What is Acute Kidney Injury defined by?

A

1) Increase in SCr by 0.3 mg/dl ( 26 mol/l) within 48 hours; or
2) Increase in SCr to 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days;
or
3) Urine volume <0.5 ml/kg/h for 6 hours.

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2
Q

What is AKI?

A

-The sudden, acute drop in function occurring over a period of hours, days or weeks

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3
Q

Is AKI reversible?

A

Depends on cause, or may lead to permanent renal failure

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4
Q

What is AKI characterized by?

A

Fluid, electrolyte and acid-base imbalances and wasting

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5
Q

What are some exposures which may lead to AKI?

A
  • Sepsis
  • Critical illness
  • Circulatory shock
  • Burns, Trauma
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6
Q

What are some susceptibilities which may lead to AKI?

A
  • Dehydration or volume depletion
  • Advance age
  • Female gender
  • Black race
  • Diabetes mellitus
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7
Q

What is prerenal AKI?

A

-Impaired blood flow to the kidneys resulting in decreased urine output and retention of N waste products

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8
Q

What causes prerenal AKI?

A

Hypovolemia due to haemorrhage, burns, diarrhea, vomiting, inadequate fluid replacement and decreased cardiac output

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9
Q

Dietary intervention in prerenal AKI?

A

Minimal dietary intervention req, will be resolved if underlying problem is treated

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10
Q

What is intrinsic AKI?

A

Damage within the kidney cells (kidney parenchyma or acute tubular necrosis)

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11
Q

What are the causes of intrinsic AKI?

A
  • Exposure to toxins such as antibiotics, chemo, contrast dyes
  • Systematic inflammatory conditions such as sepsis, acute infections (glomerulonephritis)
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12
Q

When is nutritional management critical?

A

During intrinsic AKI

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13
Q

What is postrenal (obstructive) AKI?

A

-Obstruction in the urine flow (UT obstruction)

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14
Q

Causes of postrenal AKI?

A

-Bladder cancer, benign prostate hyperplasia, strictures, blood clots, kidney stones

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15
Q

Dietary intervention in postrenal AKI?

A

Minimal, as issue will be resolved if underlying problem is corrected

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16
Q

How does KDIGO classify severity?

A

SCr and urine output

17
Q

How does RFLE classify severity?

A

-Risk, injury, failure and loss of function

18
Q

AKI Stage 1 Sr. Ceat?

A

-1.5-1.9 x baseline or >0.3 mg increase

19
Q

AKI Stage 1 u/o?

A

<0.5 ml/kg 3 hr for 6-12 hours

20
Q

AKI Stage 2 Sr. Cr?

A

2.0-2.9 x baseline

21
Q

AKI Stage 2 u/o?

A

<0.5 ml/kg/ 3 hr for >12 hours

22
Q

AKI Stage 3 Sr. Cr?

A

1) 3.0 x baseline
OR
2) >4 mg/dl increase in sr.cr
OR
3) Initiation of renal replacement therapy
OR
4) In patients <18 yrs, decrease in eGFR to <35 ml/min

23
Q

Stage 3 AKI u/op?

A

1) <0.3 ml/kg/3h >24 hours
OT
2) Anuria for >12 hours

24
Q

Symptoms and signs of AKI?

A
  • fluid retention/overload
  • Metabolic acidosis
  • Electrolyte abnormalities
  • Anemia
25
Q

Which electrolytes are often high in AKI?

A

-K, Mg and Na

26
Q

Complications of AKI

A

-hematuria
-reduced u/o
-dehydration
uremia
-side/lower back brain (obstructed urinary tract)

27
Q

What are some metabolic complications of AKI?

A
  • Decrease pro synth, increased breakdown
  • Insulin resistance
  • Azotemia
  • Anemia
  • HTN
  • High TG/Cholesterol
28
Q

AKI nutritional goals?

A
  • Minimize uremia and maintain the chemical compostions of the body as close as possible
  • Preserve LBM
  • Maintain electorlyte/acid base homeostasis
  • NS if indicated
29
Q

General dietary guidelines for AKI?

A
  • Controlled protein, phos, Na, K and fluid
  • Energy to meet req and minimize LBM breakdown
  • Consider supplementation of water soluble vitamins due to losses in dialysis
30
Q

Energy in AKI?

A

25-30 kcal/kg based on ABW (IBW if obese)

31
Q

Protein in AKI?

A

1.2-2 g/kg/day ABW

32
Q

Protein in CRRT?

A

2.5 g/kg/day ABW

33
Q

Minerals, electrolytes and trace elements?

A

Maintain serum level

34
Q

Fluid requirements?

A

Output + 400-500 ml

35
Q

What weight gain may indicate fluid retention?

A

Gain of >0.5-1kg/day could be fluids

36
Q

What should be monitored in AKI?

A
  • Daily intake/output
  • Serum electrolytes
  • BP
  • Weight gain or loss