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Sem 6: SAM 2 > AKI > Flashcards

AKI Flashcards

1
Q

What are the 4 stages of AKI?

A
  1. Initiation
  2. Extension
  3. Maintenance
  4. Recovery
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2
Q

List common etiologies and risk factors for ischemia resulting in AKI

A
  • Hypovolemia
  • Hypotension
  • Infarction
  • Pancreatitis
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3
Q

List common infectious causes resulting in AKI

A
  • Lepto
  • Pyelonephritis
  • Sepsis
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4
Q

List the most common drugs at risk for causing AKI

A
  • Aminoglycosides
  • NSAIDs
  • Amphotericin B
  • Cisplatin
  • Radiographic contrast
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5
Q

What are miscellaneous risk factors for AKI (not ischemic, toxic, infectious, or drug causes)

A
  • Hypercalcemia
  • Envenomation
  • Hyperglobulinemia
  • Heatstroke
  • Hydronephrosis
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6
Q

There are 4 stages to AKI. What is the longest stage?

A

Recovery phase (takes months)

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7
Q

In which stage of AKI is there marked polyuria?

A

Recovery phase

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8
Q

What occurs in the recovery stage of AKI?

A
  • 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
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9
Q

What occurs during the maintenance stage of AKI?

A
  • Evidence of azotemia, uremia
  • Decreased GFR
  • Oliguria: Urine output <0.5 mL/kg/hr
  • +/- anuria
  • This phase takes days to weeks post injury
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10
Q

What is the IRIS AKI staging based on?

A
  • Based on creatinine levels
  • Grade 1-5
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11
Q

How is AKI subgraded?

A
  • Subgraded as non-oliguric or oliguric vs requiring RRT (dialysis)
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12
Q

What is the fluid of choice for addressing AKI?

A
  • LRS

(dont use 0.9% NaCl!!!)

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13
Q

Which fluid should be avoided in patients with AKI?

A
  • Avoid 0.9% NaCl
  • NaCl is acidifying and can decrease renal blood flow
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14
Q

What is oliguria defined as?

A

Urine output < 0.5 mL/kg/hr in a hydrated, volume expanded patient

(decreased volume of urine)

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15
Q

What are indications for hemodialysis and RRT?

A
  • 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)

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16
Q

What occurs during the initiation stage of AKI?

A
  • Decreased ATP
  • Cell swelling
  • Decreased O2 delivery
17
Q

What occurs during the extension stage of AKI?

A

- Ischemia
- Inflammation
- Apoptosis
- Necrosis
- Evidence of granular casts

18
Q

What is a classic late stage finding in AKI that is indicative of a poor prognosis?

A

Hyperkalemia

19
Q

What is a classic finding seen on urinalysis with AKI patients?

A

Granular casts indicating intrinsic renal damage

20
Q

What are common sequelae to AKI?

A
  • Hypertension
  • Metabolic acidosis
  • Hyperkalemia
  • Oliguria
21
Q

What is the best way to monitor urine output in a patient with AKI?

A

Via indwelling catheter and closed collection

22
Q

When is use of diuretics to manage AKI contraindicated?

A
  • Contraindicated in dehydrated patients!!
23
Q

What drug treatments can be given to hydrated AKI patients to treat oliguria?

A

- Furosemide
- Mannitol
- Fenoldopam

24
Q

What is the drug of choice to treat hypertension associated with AKI?

A
  • Amlodipine
  • Telmisartan
  • Fenoldopam

(Note: Don’t use ACEi!!! Takes too long to work)

25
Q

What supportive and symptomatic care should be provided when managing AKI patients?

A
  • Feeding tube
  • Antacids and GI protectants to help uremic ulceration
  • Antiemetics, prokinetics
  • Appetite stimulants

Note: Renal diet is NOT indicated for AKI patients

26
Q

What does hypotension refractory to volume replacement therapy indicate when treating AKI patients?

A
  • Sepsis / septic shock
  • Negative prognostics indicator 😔
27
Q

What evidence leads to diagnosis of stage II AKI?

A

Creatinine > 1.7 - 2.5

28
Q

What evidence leads to diagnosis of stage III AKI?

A

Creatinine > 2.6 - 5

29
Q

What evidence leads to diagnosis of stage IV AKI?

A

Creatinine > 5.1 - 10

30
Q

What evidence leads to diagnosis of stage V AKI?

A

Creatinine > 10

31
Q

What is the drug of choice for treating AKI due to leptospirosis infection?

A

Ampicillin or Doxycycline

32
Q

What is the drug of choice for treating AKI due to pyelonephritis?

A

Enrofloxacin (fluoroquinolone)

33
Q

What is the drug of choice for treating AKI due to acute ethylene glycol ingestion?

A

4-MP or Fomepizole

Sem 6: SAM 2 (34 decks)

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