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AKI Flashcards

1
Q

What must be present to confirm an AKI?

A
  1. SCr increase >/= 0.3 mg/dL within 48 h
  2. SCr increase by at least 1.5 times baseline in 7 days
  3. decrease in volume to less than 0.5 ml/kg/h
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2
Q

What is a stage 1 AKI?

A
  1. SCr increase >/=0.3 OR
  2. 1.5-1.9 fold increase in SCr from baseline OR
  3. <0.5 ml/kg/h for >/= 6-12 h
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3
Q

What is a stage 2 AKI?

A
  1. SCr increase 2-2.9 fold from baseline OR
  2. <0.5ml/kg/h for >/=12h
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4
Q

What is a stage 3 AKI?

A
  1. SCr > 3 fold increase from baseline OR
  2. SCr >/= 4mg/dl OR
  3. need for RRT OR
  4. eGFR <35 in patients < 18 years old OR
  5. anuria >/= 12h
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5
Q

Who made the stages for AKI?

A

KDIGO

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6
Q

How long does it take for SCr to increase after the start of an AKI?

A

1-2 days

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7
Q

What are the causes of a prerenal AKI?

A
  1. hypovolemia
  2. reduced cardiac output
  3. systemic vasodilation
  4. renal vasomodulation/ shunting
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8
Q

What are the causes of an intrinsic AKI?

A
  1. vascular/microvascular
  2. glomerular injury
  3. tubulointerstitium (obstruction)
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9
Q

What are the causes of postrenal AKI?

A
  1. bladder outlet obstruction
  2. ureteral obstruction
  3. kidney stones
  4. swelling of abdomen
  5. cancers
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10
Q

What is a diagnostic tool for differentiating AKI?

A

Fraction Excreted Na (FENA)

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11
Q

What type of AKI has characteristics of low urine sodium and a FENA of <1% ?

A

prerenal

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12
Q

What type of AKI has characteristics of elevated urine sodium and a FENA of 2-3% ?

A

intrinsic

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13
Q

What are clinical presentations of an AKI?

A
  1. decreased urine output
  2. urine discoloration
  3. sudden weight gain
  4. severe abdominal or flank pain
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14
Q

What labs indicate an AKI?

A
  1. elevated BUN
  2. increased SCr
  3. BUN:Cr ratio
  4. FENA
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15
Q

What can alter the accuracy of FENA equation? What should be done?

A
  1. diuretic use
  2. see how long the drug lasts
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16
Q

What is the mechanism of prerenal AKI?

A

decreased renal perfusion usually due to volume depletion

17
Q

What is the mechanism of intrinsic AKI?

A

structural damage to the kidney tissue usually due to ischemia or toxins

18
Q

What is the mechanism of post renal AKI?

A

obstruction of urine flow downstream

19
Q

What is the most common type of hospital/ ICU aquired AKI?

20
Q

What FENA, BUN/SCr, specific gravity indicates prerenal AKI?

A
  1. FENA: <1
  2. BUN/SCr : >20 (dehydration)
  3. urine specific gravity: >1.018
21
Q

What FENA, BUN/SCr, specific gravity indicates intrinsic AKI?

A
  1. FENA: >2
  2. BUN/SCr : ~15
  3. urine specific gravity: <1.012
22
Q

What FENA, BUN/SCr, specific gravity indicates postrenal AKI?

A
  1. FENA: variable
  2. BUN/SCr : ~15
  3. urine specific gravity: variable
23
Q

How do we prevent AKIs?

A
  1. review medications for nephrotoxicity
  2. adjust renally cleared meds
  3. optimize hemodynamics
  4. hydration
24
Q

What prevention strategy consistently shows benefit?

25
When should hydration be given to patients receiving contrast dyes?
prior to and after receiving contrast dyes
26
What fluids are options to prevent AKI?
1. NS 2. sodium bicarbonate 3. plasmalyte 4. lactated ringers
27
What is the glycemic target for ICU patient?
140-180 mg/dL
28
What are nonpharm therapies for AKI?
1. fluid boluses with NS 2. red blood cell transfusions 3. elimination of meds associated with kidney damage 4. electrolyte management 5. improve cardiac output 6. RRT
29
What are treatments to manage fluid overload?
1. IV loop diuretics
30
What is the mechanism of diuretic resistance?
1.decreased diuretic secretion into the tubular lumen 2. severe hypoalbuminemia
31
What are treatment options for diuretic resistance?
1. high dose IV bolus doses 2. continuous infusion of diuretics 3. 25% albumin and loop 4. loop and thiazide
32
What are the indications for RRT?
A: acid/base abnormality E: electrolyte imbalance (hyperkalemia, hypermagnesemia) I: intoxications O: fluid overload U: uremia
33
What drugs can lead to RRT?
1. salicylates 2. lithium 3. methanol 4. ethelyne glycol 5. theophylline 6. phenobarbitol
34
The use of what fluids are associated with having proinflammatory effects and can activate leukocytes if used for fluid management of AKI?
LR

Critically Ill (20 decks)

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