AKI- MJ Flashcards
What is the definition of AKI?
>50% decrease in GFR over a period of hours to days, with any accompanying accumulation of nitrogenous wastes in the body and inability to maintain fluid and electrolyte balance
(all occuring over less than 3 months)
What is the KDIGO classification of AKI? (3)
Increase in creatinine by > 0.3 w/in 48hrs
OR
Increase in creatinine >1.5x baseline, which occured w/in the last 7 days
OR
Urine volume < 0.5mL for 6 hrs
According to KDIGO, what is the creatinine and urine output criteria for stage 1 AKI?
(note: creatinine criteria is more important than urine output)
Creatinine criteria: Cr 1.5-1.9x baseline OR Cr increase >0.3
Urine output criteria: <0.5mL x6-12 hrs
According to KDIGO, what is the creatinine and urine output criteria for stage 2 AKI?
(note: creatinine criteria is more important than urine output)
Creatinine criteria: Cr 2-2.9x baseline
Urine output criteria: <0.5ml x >12 hours
According to KDIGO, what is the creatinine and urine output criteria for stage 3 AKI?
(note: creatinine criteria is more important than urine output)
Creatinine Criteria:
- Cr >3x baseline OR
- Cr >4mg/dL OR
- Initiation of dialysis
Urine output Criteria:
- <0.3ml x >24hrs OR
- anuria x >12hrs
What is the main difference between the AKIN (Acute Kidney Injury Network) from the KDIGO classifications for staging of AKI?
The main difference is in stage 3 where AKIN also includes the following serum criteria:
Increases in Cr to >3x baseline (or Cr >4mg/dl) w/ an acute increase of at least 0.5mg/dl
What is the RIFLE (Acute Dialysis Quality Initiative) classification for AKI?
(old, not preferred method)
- Risk- Cr 1.5 x normal
- Injury- Cr 2 x normal
- Failure- Cr 3 x normal (acute rise > 0.5mg/dl)
- Loss- Loss of function for > 4 weeks
- End- ESRD- Complete loss of function > 12 weeks
If a patient is admitted to the ICU due to AKI, what is the mortality rate of this group?
Of those that survive, 30% remain on what?
- In hospital mortality= 40-65%
- Those who survive, 30% remain on long term dialysis
How much urine produced in 24hrs is considered nonoliguia? Oliguria? Anuria?
How do you monitor urine output in real time?
Nonoliguria= >500ml
Oliguria= <500ml
Anuria= <100ml
Monitor using a foley catheter
Is prerenal, intrinsic or postrenal AKI most common?
Prerenal (60-70%)
What labs and diagnostic studies should be ordered for evaluation of AKI?
•Labs
- Urine studies (UA, urine Na, urine osmolality)
- CBC, serum electrolytes
•Diagnostics
- Ultrasound or possibly CT
- EKG
What is the first line diagnostic tool for evaluating the kidney?
ultrasound
Is the normal range of serum creatinine higher in a male or female?
Greater than 4mg/dl indicates what?
- Higher in males (b/c of muscle mass)
- Greater than 4mg/dL= serious renal impairment
What is the relationship between creatinine levels and GFR?
(as GFR decreases, what happens to Cr?)
Inverse relationship: As GFR decreases, creatinine increases
(If GFR is 1/2 normal, Cr will be 2x normal)
What is the BUN/Creat ratio for prerenal AKI? What is the Fractional excretion NA (FENa)?
BUN/Creat ratio= >20:1
FENA= <1%
What is the BUN/Creat ratio for intrarenal AKI? What is the Fractional excretion NA (FENa)?
BUN/Creat ratio= <20:1
FENA= >3%
What is the BUN/Creat ratio for postrenal AKI? What is seen on UA?
BUN/Creat= <20:1
UA= Hyaline casts
What is seen on UA for intrinsic AKI?
Dark Granular casts
What is the most sensitive way to differntiate prerenal vs acute tubular necrosis (intrinsic)?
Fractional Excretion of Sodium (FENa)
What is the FENa in prerenal vs intrinsic AKI?
prerenal= <1%
intrinsic= >3%
if 1-3%= either or both
T/F: Do low or high fluid statuses cause prerenal AKI?
True
Ex of low: anemia, hemorrhage, dehydration
Ex of high: Cardiovascular states (did not focus on this)
Prerenal Azotemia is characterized by what?
Inadequate blood perfusion to the kidneys
What are the 3 main overarching etiologies of prerenal azotemia?
- Vascular Depletion
- Low Cardiac Output
- Change in vascular resistance
Prerenal Azotemia etiologies:
Vascular depletion–> hypovolemia from what?
- Renal loss
- Addisons, DKA, etc
- Extrarenal loss
- Vomiting, diarrhea, pancreatitis, burns, sweating, etc