AKI Flashcards
What are the 4 stages of AKI?
- Initiation
- Extension
- Maintenance
- Recovery
List common etiologies and risk factors for ischemia resulting in AKI
- Hypovolemia
- Hypotension
- Infarction
- Pancreatitis
List common infectious causes resulting in AKI
- Lepto
- Pyelonephritis
- Sepsis
List the most common drugs at risk for causing AKI
- Aminoglycosides
- NSAIDs
- Amphotericin B
- Cisplatin
- Radiographic contrast
What are miscellaneous risk factors for AKI (not ischemic, toxic, infectious, or drug causes)
- Hypercalcemia
- Envenomation
- Hyperglobulinemia
- Heatstroke
- Hydronephrosis
There are 4 stages to AKI. What is the longest stage?
Recovery phase (takes months)
In which stage of AKI is there marked polyuria?
Recovery phase
What occurs in the recovery stage of AKI?
- Regen and tubular repair
- Improving azotemia
- Marked polyuria (which is good bc peeing out solutes)
- Return to normal function vs residual damage
- Longest phase, can take months
What occurs during the maintenance stage of AKI?
- Evidence of azotemia, uremia
- Decreased GFR
- Oliguria: Urine output <0.5 mL/kg/hr
- +/- anuria
- This phase takes days to weeks post injury
What is the IRIS AKI staging based on?
- Based on creatinine levels
- Grade 1-5
How is AKI subgraded?
- Subgraded as non-oliguric or oliguric vs requiring RRT (dialysis)
What is the fluid of choice for addressing AKI?
- LRS
(dont use 0.9% NaCl!!!)
Which fluid should be avoided in patients with AKI?
- Avoid 0.9% NaCl
- NaCl is acidifying and can decrease renal blood flow
What is oliguria defined as?
Urine output < 0.5 mL/kg/hr in a hydrated, volume expanded patient
(decreased volume of urine)
What are indications for hemodialysis and RRT?
- Decontamination of AKI toxins
- Supporting kidney function until recovery phase
- Used during the maintenance phase of AKI!! (oliguric phase)
- CRRT is better for unstable AKI patients with oliguria or fluid overload
(NOT used during the recovery phase)
What occurs during the initiation stage of AKI?
- Decreased ATP
- Cell swelling
- Decreased O2 delivery
What occurs during the extension stage of AKI?
- Ischemia
- Inflammation
- Apoptosis
- Necrosis
- Evidence of granular casts
What is a classic late stage finding in AKI that is indicative of a poor prognosis?
Hyperkalemia
What is a classic finding seen on urinalysis with AKI patients?
Granular casts indicating intrinsic renal damage
What are common sequelae to AKI?
- Hypertension
- Metabolic acidosis
- Hyperkalemia
- Oliguria
What is the best way to monitor urine output in a patient with AKI?
Via indwelling catheter and closed collection
When is use of diuretics to manage AKI contraindicated?
- Contraindicated in dehydrated patients!!
What drug treatments can be given to hydrated AKI patients to treat oliguria?
- Furosemide
- Mannitol
- Fenoldopam
What is the drug of choice to treat hypertension associated with AKI?
- Amlodipine
- Telmisartan
- Fenoldopam
(Note: Don’t use ACEi!!! Takes too long to work)
