Lect 1 Flashcards
Anuria
less than 100 mL/day
Oliguria
100-400 mL/day
Non-oliguria
> 400 mL/day
Non-oliguria
> 400 mL/ day
high risk patients
preexisting renal insuffienciency, congestive HF, cirrhosis, diabetes, age, dehydration, nephrotoxic drugs, IV dye, critical illness
what are some examples of nephrotoxic agents?
aminoglycosides, amphotericin B, cisplatin, carboplatin, IV contrast dye
what agents have an impact on renal blood flow?
NSAID, ACE-I, cyclosporine, tacrolimus
goal of volume expansion therapy
maintain urine output >150 mL/hr
volume expansion
NS (preferred in critically ill): 1-1.5 mL/kg/hr 3-12 hours before and after IV contrast exposure
sodium bicarbonate: 3 mL/kg/hr for 1 hour prior and 1 mL/kg/hr for 6 hours after
prevention of AKI with amphotericin B
lipid formulations preferred over conventional
prevention of AKI with amphotericin B
lipid formulations preferred over conventional
N-acetylcysteine (Mucomyst)
scavenges free oxygen radicals
as adjunct to IV isotonic crystalloids
expensive
600-1200 mg BID day before and day after IV contrast administration
which are NOT recommended for prophylaxis?
theophylline, ascorbic acid, statins, fenoldopam (DA-1 agonist w/ risk of hypotension), dopamine, diuretics (mannitol and furosemide)
insulin
may have direct protective effect (decrease in development of ARF)
Target glucose 110-149 mg/dL
insulin
may have direct protective effect (decrease in development of ARF)
Target glucose 110-149 mg/dL
treatment of postrenal AKI
removal of obstruction, supportive therapy (electrolyte management, fluid management)
hypovolemic considerations
normal saline is IV fluid of choice
hypervolemic considerations
reduce IV fluids to “keep vein open”
conc of IV meds
conc of tube feeds
diuretics should be reserved for ___
hypervolemic patients who make adequate urine in response to diuretics
diuretics examples
- furosemide (Lasix)
- torsemide (Demadex)
- bumetanide (Bumex)
- ethacrynic acid (Edecrin)= reserved for pts with sulfa allergy
potency of IV loop diuretics
bumetanide:torsemide:furosemide (1:20:40)
potency of IV loop diuretics
bumetanide
which loop has the best oral bioavailability?
bumetanide
which loop has longest duration of action?
torsemide
goal of diuretics
maintain urine output >1 mL/kg/hr until euvolemic
continuous administration of diuretics
fewer adverse rxns (myalgia, ototox); more natriuresis occurs; more expensive and requires more monitoring
continuous administration of diuretics
fewer adverse rxns (myalgia, ototox); more natriuresis occurs; more expensive and requires more monitoring
causes of diuretic resistance
excessive Na intake, inadequate dose, reduced bioavailability, nephrotic syndrome, reduced renal blood flow (drugs, hypotension), increase Na resorption
how can you restore function from diuretic resistance?
add thiazide or potassium-sparing diuretics
If CrCl less than 30 mL/min, thiazides lose effectiveness (except for metolazone)
what is not recommended as treatment fro AKI?
dopamine
what is the most common non-pharm treatment that AKI pts receive?
renal replacement therapy (RRT)
indications for RRT
Acid-base abnormalities Electrolyte imbalance Intoxication fluid Overload Uremia
