Lecture 5

Question 1

What constitutes AKI

Answer 1

Increase in Cr by 0.3 or more within 48 hours

Increase in Cr 1.5x or more baseline

Urine production less than 0.5 ml/kg/hr for 6 hours

Question 2

What are the phases of AKI

Answer 2

Initiation (primary insult)
Extension (cell apoptosis)
Maintenance
Recovery (may takes months to years)

Question 3

RIFLE

Answer 3

Risk
Injury
Failure
Loss of function
End stage renal disease

Question 4

Describe IRIS staging system

Answer 4

Grade 1: cr less than 1.6
Grade 2:cr 1.7-2.5
Grade 3: 2.6-5
Grade 4: 5.1-10
Grade 5: 10 or greater

*each grade is subdivided into non oliguric or oligoanuric and requiring renal replacement therapy

Question 5

Management of AKI principles

Answer 5

Identify/correct pre and post renal factors
Abx
Identify and treat acute complications
Review other drugs
Monitor fluid balance and daily body weight
Optimize nutrition
Manage GI signs
Renal replacement therapies or vasopressors

Question 6

When correcting dehydration as a pre renal factor, what fluids should you avoid?

Answer 6

Avoid Cl rich fluids and synthetic colloids

Question 7

What post renal factors should you keep in mind

Answer 7

Uroliths and obstruction

Question 8

What acute complications should you be on the lookout for and treat?

Answer 8

Hyperkalemia, acidosis

Question 9

When reviewing the drugs your patient is being given, which drugs should you avoid?

Answer 9

Aminoglycosides
NSAIDs
Be careful with sedation

Question 10

Why monitor fluid balance and daily body weight?

Answer 10

Monitor for volume overload! Be on the lookout for edema

Question 11

What GI signs might occur?

Answer 11

Uremic gastritis because decreased gastrin elimination

Question 12

Other therapies?

Answer 12

Furosemide, fenoldopam (both have no evidence for being helpful)

Vasopressors are probably beneficial, esp norepinephrine