Acute Kidney Injury (AKI)

Question 1

Definitions of AKI ?

Answer 1

life-threatening syndrome characterized by a
rapid (hours to days) deterioration of kidney
function, with or without a decrease in urine
output

Question 2

What are the clinical consequences of AKI?

Answer 2

1. The accumulation of Waste products & Electrolytes & fluid
2. reduced immunity & possibility of
   organ cross-talk (non-renal organ dysfunction)

Question 3

KDIGO diagnostic criteria for AKI ?

Answer 3

1. increase SrCr by ≥0.3 mg/dl within 48 h. or
2. SrCr ≥1.5 times baseline, which is known to have occurred within the prior 7 days, or
3. Urine volume <0.5 ml/kg/h for 6 h

Question 4

What are the most common causes of AKI in critically ill pts?

Answer 4

1. Sepsis
2. HF
3. Hemodynamic instability
4. Hypovolemia
5. Exposure to nephrotoxic substances

Question 5

3 types of etiology of AKI?

Answer 5

1. pre renal
2. post renal
3. renal (intrinsic)

Question 6

Cause of pre renal?

Answer 6

Resulting from decreased renal perfusion in the setting of undamaged parenchymal tissue

Question 7

Cause of post renal

Answer 7

Resulting from obstruction of urine flow downstream from the kidney

Question 8

Cause of renal (intrinsic)?

Answer 8

Resulting from structural damage to the kidney,
most commonly the tubule from an ischemic or
toxic insult

Question 9

What are the clinical courses of AKI ?

Answer 9

1. oliguric phase
2. diuretic phase
3. recovery phase

Question 10

Oliguric phase

Answer 10

Occurs over 1 to 2 days, last for days to several weeks

Question 11

Diuretic phase

Answer 11

Increased urine production occurs for several days, signaling the initial repair of the kidney insult

Question 12

Recovery phase

Answer 12

Over weeks to months, depending on the severity of the pt’s AKI

Question 13

What are the Clinical Evaluation for diagnosis of AKI?

Answer 13

1. Recent surgery/ hemorrhage or prophylactic antibiotics (nephrotoxin exposure )
2. Concurrent medical conditions (pt have pre-existing conditions that point toward prerenal AKI, such as CHF)
3. Patient’s volume status (e.g., evidence of dehydration: syncope, weight loss, orthostatic hypotension) or (decreased effective circulating volume: ascites, PE, peripheral edema)

Question 14

GFR [90 to 120 mL/min] is one of the most widely used clinical measures to?

Answer 14

1. determine baseline kidney function
2. monitor progression of kidney disease

Question 15

Creatinin, Cr

Answer 15

used clinically for the estimation of GFR

Question 16

Signs of AKI ?

Answer 16

1. Peripheral edema
2. Colored or foamy urine
3. Volume depletion (prerenal AKI)
4. Anuria alternating with polyuria
   (postrenal AKI)

Question 17

Symptoms of AKI?

Answer 17

1. Weight gain
2. Nausea, vomiting, diarrhea, anorexia
3. SOB
4. Pruritus
5. Colicky abdominal pain radiating from
   flank to groin (postrenal AKI)

Question 18

What is the Ultimate goal for treatment of AKI?

Answer 18

Restoration of renal function to pre-AKI baseline

Question 19

GENERAL APPROACH TO TREATMENT of AKI

Answer 19

No definitive therapy for AKI. Supportive care is the mainstay of AKI management regardless of etiology

Question 20

Nonpharmacologic Therapies for AKI?

Answer 20

1. Maintenance of adequate CO & BP -> Optimize tissue perfusion
2. Discontinue medications associated with diminished renal blood flow
3. Initiate appropriate fluid & electrolyte management

Question 21

Nonpharmacologic Therapies for severe AKI?

Answer 21

Renal replacement therapy (RRT); e.g. HD or PD
Maintains fluid & electrolyte balance while removing waste products

Question 22

But RRT not always indicated in AKI. Reserved for the cases of….

Answer 22

1. Severe acid-base disorders
2. Fluid overload
3. Hyperkalemia
4. Symptomatic uremia
5. Drug intoxications

Question 23

Pharmacologic Therapies in AKI ?

Answer 23

Loop diuretics are the diuretics of choice for managing volume overload in AKI