AKI (Part I) Flashcards
What is the risk factor for CKD & ESRF?
AKI
What is the definition of AKi?
- Reduced UO < 0.5ml/kg/hr for 6hrs
- Increased creatinine > 1.5 of baseline in 7 days
- Increased creatinine > 0.3mg/dL or 26.5 micromol/L in 48hrs
Stimulants from the production of ADH?
- Stress
- Pain
- Hypovolaemia
What is KDIGO?
Kidney Disease Improving Global Outcomes - Established in 2012
What is AKD ?
AkI persisting for > 7 days
What is CKD?
AKD persistent until day 90
What is creatinine?
- Metabolite of creatine phosphate
- Falls in critical illness
What is creatine phosphate?
Synthesized from the below in the liver & kidney;
- Amino acids
- Glycine
- Arginine
Creatine phosphate energy potential?
Mobilizable reserve of high energy phosphate in skeletal muscles
Determinants of creatinine production?
- Determined by muscle mass
- Meat intake
- Amount of creatine generated in the liver & kidney
Limitations of creatinine as a marker for renal function?
- Takes 24-36hrs to rise after renal insult
- Drug induced change in conc. w/o change in renal function
- Unreliable in sepsis, liver disease or muscle wasting
- Affected by volume status - Undiagnosed in hypervolaemia
- Baseline required
Analytic assessment of creatinine?
Jaffe-based assay
Drugs interfering with creatinine?
- Cimetidine - Rise of creatinine
- Trimethoprim - Rise of creatinine
Conditions causing oliguria?
- Fasting
- Surgery
- Stress
- Hypovolaemia
- Pain
- Trauma
Physiologic & pathologic oliguria?
See image attached
What is cystatin C?
- Produced by all nucleated cells
- Low MW facilitating glomerular filtration
- Reabsorbed in the renal tubules
- Catabolized in the proximal tubular cells
- Conc influenced by steroids & thyroid Fx
- More accurate in critically ill than creatinin
- Shorter half-life than creatinine
- Presence in urine is a marker of kidney injury
Furosemide stress test?
- 1mg/kg or 1.5mg/kg if furosemide in last 7 days
- If UO is < 200ml in 2 hrs - Risk of progression of AKI and RRT
Furosemide action?
- Binds to albumin
- Actively secreted into the tubular lumen in PCT
- Delivered to the thick ascending limb of LoH
- High sensitivity & specificity for RRT