AKI Flashcards
Causes of anuria x5
Shock
Kidney cortical necrosis
Hemolytic uremic syndrome
Bilateral renal artery obstruction
Complete bilateral urinary tract obstruction
Define AKI x3
Increase in serum creatinine by 0.3mg/dl within 24 hours
Increase in serum creatinine to 1.5 times baseline within 1 week
Urine volume < 0.5mkl/kg/hour for 6 hours
How is creatinine filtered x2 and which medicine interferes with that
Glomerular filtration
Proximal tubular secretion
Trimethoprim - reduces tubular secretion
Causes of elevated urea levels x4
Renal injury
Steroid use
High protein diet
Severe catabolism
GI or mucosal bleeding
Why does AKI matter x3
Increased risk of infection
Altered drug metabolism
Increase risk of CKD
RIFLE Classification
Risk: Cr x1,5, GFR decrease >25%
Injury: Cr x2, GFR decrease >50%
Failure: Cr x3, GFR decrease >75%
Loss: complete loss of renal function
End stage renal disease
Causes of pre renal AKI x5
Sepsis
Hypovolemia
Severe anemia
Cardiorenal syndrome
NSAIDs, ACE inhibitors
Pathophysiology of prerenal AKI
Decreased circulatory volume > activation of baroreceptors> activation of sympathetic nervous system and RAAS> increased ADH. Angiotensin ll and norepinephrine> renal vasoconstriction > decreased GFR
Causes of ATN x5
Drugs
Toxins
Infections
Cytokines
Prolonged ischemia
Intrinsic AKI - vascular causes x3
TTP/HUS
Vasculitis
Malignant hypertension
Examples of exogenous and endogenous nephrotoxins x4
Exo - iodinated contrast, aminoglycosides
Endo - hemolysis> heme proteins and rhabdomlysis > myoglobin
Causes of postrenal AKI x4
BPH
Tumor
Kidney stones
Neurogenic bladder
Drugs and the area they affect x4
Preglomerular- cyclosporine
Glomerular- NSAIDs
Proximal tubule - aminoglycosides, radiocontrast dye
Distal tubule- ACE inhibitors
Interstitial - penicillin
Urine osmolality formula
2(Na + K) + urea/2.8 + glucose/18
Management of AKI x4
Fluid resuscitation
Diuretics if fluid overload
Treat underlying causes eg infection
Treat complications eg acidosis and hyperkalemia
