AKI (Selby) Flashcards
AKI stage 1
1.5-1.9 times baseline or >0.3 mg/dL increase of serum creatinine
or
<0.5mL/kg for 6-12 hours
AKI stage 2
2.0-2.9 times baseline creatinine
or
<0.5 mL/kg for >12 hours
AKI stage 3
3 times baseline or >4.0mg/dl increase of serum creatinine
or
<0.3 mL/kg for >24 hours or anuria for >12 hours
prerenal AKI cause
hypotension
hypovolemia
reduced CO
systemic vasodilation
postrenal AKI
bladder outlet obstruction (BPH/cancer/blood clot)
ureteral obstruction
renal pelvis (papillary necrosis or stones)
intrinsic AKI
tubular necrosis (85%) interstitial nephritis (10%) glomerulonephritis (5%)
tubular necrosis
ischemia (50% of intrinsic cases)
toxins (35% of intrinsic cases)
clinical presentation of AKI
edema HTN oliguria foamy urine hematuria SoB (if pulmonary edema) uremia (nausea/vomiting) pericardial friction rub asterixis uremic frost
labs to obtain for AKI
urinalysis with urine microscopy
urine albumin/creatinine ration or urine protein/creatinine ratio
renal US in AKI
rule out hydronephrosis
evaluate size
cortical thickness
if doppler can assess renal vein thrombosis or renal artery stenosis
BUN:creatinine in AKI
> 20:1 suggestive of prerenal azotemia
FeNa <1%
prerenal azotemia
FeNa>2%
ATN
FeUrea <35%
prerenal azotemia
FeUrea >50%
ATN
renal biopsy in AKI
reserved for sever AKI with unclear etiology
urine eosinophils good for
AKI
complications of AKI
hypovolemia electrolyte abnormalities hyperuricemia uremia pericarditis metabolic acidosis bleeding need for dialysis
electrolyte abnormalities in AKI
hyperkalemia
hyperphosphatemia
hypermagnesemia
hypocalcemia
bleeding in AKI
platelet dysfunction occurs with BUN > 100
treatment for AKI is mostly
supportive
also correct underlying condition
prerenal AKI need
fluids
ATN need
supportive care
glomerulonephritis AKI need
probably immunosuppression or plasmapheresis
