Nephro-AKI Flashcards
Definition of AKI?
0.3 increase
Urinalysis and microscopy for:
- Prerenal
- ATN
- AIN
- Acute GN
- Intratubular obstruction
- Acute vascular syndromes
- Postrenal
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Pre-renal: normal or hyaline casts
ATN: pigmented granular/muddy brown casts and tubular epithelial cells
AIN: mild proteinuria, leukocytes, erythrocytes, leukocyte casts, eosinophiluria
Acute GN: Proteinuria, dysmorphic erythrocytes, erythrocyte casts
Intratubular obstruction: crystalluria or pence-jones proteinuria
Acute vascular syndromes: Variable hematuria
Post-renal: Variable bland
FeNA of prerenal AKI and ATN
Pre-Renal: <1%
ATN: >2%
When does contrast induced nephropathy occur?
within 24-48 hours after exposure
What is hepatorenal syndrome?
reversible form of AKI that occurs with advanced liver cirrhosis or fulminant hepatic failure
Tumor Lysis Syndrome
Massive release of uric acid, potassium, and phosphate into the blood from rapid lysis of malignant cells
Usually seen after initiation of cytotoxic therapy for hematologic malignancies with a large tumor burden
How does AKI occur from TLS?
intratubular precipitation of uric acid and calcium phosphate crystals
What are the clinical features of TLS?
hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia
How is TLS managed?
aggressive volume expansion, management of hyperkalemia, preventive therapy for hyperuricemia
- Allopurinol decreases uric acid production and rasburicase can also be used
- Severe cases may need plasmapheresis
Who should rasburicase be avoided in?
Rasburicase should be avoided in patients with G6PD deficiency because it can induce severe hemolysis and methemoglobinemia
What is abdominal compartment syndrome and how does it impact kidney function?
It is elevated intraabdominal pressure >12mmHg with new organ dysfunction.
Increasing abdominal pressure compresses abdominal viscera and leads to intra-abdominal organ impairment and cardiac, respiratory, and neurologic impairment. o
Oliguric AKI results from renal vein and artery compression
