AKI

Question 1

What is the most common method of measuring Kidney Fnx?

Answer 1

GFR (difficult to measure directly)

Question 2

What is MC’ly used to measure fnx of Kidney?

Answer 2

SCr
- Endogenous substance - by product of muscle metabolism

• levels are muscle mass based, not accurate in elderly and kids.

Question 3

What is direct & indirect measure of SCr?

Answer 3

Direct –> 24hrs Urine

Indirect –> Calculation based on SCr

Question 4

When calculating CICr, when do you use IBW?

Answer 4

• Use actual body wgt she it is less than IBW

- Use adjusted body wgt when it’s >**20% of IBW

Question 5

JK is 26yo F

• wgt = 120lbs
• ht = 68in
• SCr = .7 mg/dl

***For FEMALES multiply 0.85 to equation of CICr

What is CICr?

Answer 5

CICr = {[(140 - age )*IBW)] / (.72 x72)} * 0.85(F)

CICr = {[(140-26)54.54] / (.772)} * 0.85

CICr = {(6,217.56) / (50.4)} * 0.85

CICr = 104.86

Question 6

JK is 45yo F

• wgt = 356lbs
• ht = 68in
• SCr = 1.1 mg/dl

***For FEMALES multiply 0.85 to equation of CICr

What is CICr?

Answer 6

CICr = {[(140 - age )*IBW)] / (1.1 x72)} * 0.85(F)
Actual Wgt = 356lb
IBW = 140.56
ABW = (IBW+0.4(actual wgt - IBW)
         = (63.64 + 0.4(161.82-63.64))
         = 103.1kg

CICr = {[(140-45)103.1] / (1.172)} * 0.85

CICr = {(9794.5) / (79.2)} * 0.85

CICr = 105.1

Question 7

Pathophysiology of AKI?

Answer 7

• Pre-renal Azotemia
• Structural Damage
• Obstruction of outflow

Question 8

AKI - Presentation?

Answer 8

• ↑ Scr,
• ↓ GFR,
• Wt gain,
• Foamy urine,
• Accumulation of nitrogenous waste

Question 9

AKI - RFs?

Answer 9

• Hx of CKD,
• ↑ Age,
• DM,
• Dehydration

Question 10

AKI - Staging?

Answer 10

• NON-oliguria > 400 mL
• Oliguria < 400 mL
• Anuria < 50 mL / Day

Question 11

AKI - Med induced d/t Vasoconstrictors?

Answer 11

• ***NSAIDS
• Cyclosporine,
• Tacrolimus
• Amphotericin B
• ***IV contrast
• Vasopressors

Question 12

AKI - Med induced d/t Vasodilators?

Answer 12

• ACE
• ARB
• Diltiazem
• Verapamil

Question 13

AKI - Med induced d/t Neprotoxins?

Answer 13

• Aminoglycosides,
• Amphotericin B,
• Cisplatin,
• Carboplatin,
• IV contrast

Question 14

AKI - Prevention?

Answer 14

• Adequate hydration prior to contrast / procedure

- N-acetylcysteine before contrast

Question 15

AKI - Tx?

Answer 15

• Hypervolemic pt → Diuretic / renal replacement therapy
• Hypovolemic pt → Fluids (crystalloid, colloid)
• Med-Induced → Stop med, administer steroids
• Review all meds for renal dose adjustment
• NO DRUG to accelerate recovery of ARF***