Renal: AKI Flashcards
This process is defined by:
- urea/nitrogen retention
- dysreg of volume status and lytes
- based on GFR or urine output
AKI
KDIGO defines AKI as…
increased Cr of 0.3 + within 48 hrs
OR
Increased Cr by 50% in 7 days
OR
urine output < 0.5 ml/kg/hr for > 6 hours
Which KDIGO stage?
increased Cr of 0.3 + within 48 hrs
OR
Increased Cr by 50-99% in 7 days
OR
urine output < 0.5 ml/kg/hr for > 6-12 hours
stage 1
Which KDIGO Stage?
Increased Cr by 100-199% in
OR
urine output < 0.5 ml/kg/hr for > 12-24 hours
Stage 2
Which KDIGO stage?
increased Cr of 0.3 to 0.4+
OR
Increased Cr by 200+%
OR
urine output < 0.3 ml/kg/hr for 24+ hours
OR
anuria for 12+ hours
OR
Renal replacement therapy
stage 3
AKI develops in what percent of ICU patients?
60%
What is the MC type of AKI in hospitalized patients?
pre-renal
Which type of AKI?
decreased renal perfusion
pre-renal
Which type of AKI?
pathology of vessels, glomeruli or tubules
can be caused by acute tubular necrosis
intrinsic renal
Which type of AKI?
obstruction
post-renal
Can etiologies of AKI overlap?
yes! decreased perfusion can lead to acute tubular necrosis (pre-renal + intrinsic)
Rank the incidence of AKI types
ATN (45%) > Prerenal (20% > obstruction (10%)
5 things that can cause pre-renal AKI…
true volume depletion hypotension edema renal artery ischemia GFR drugs
Which two drugs can affect GFR and cause pre-renal AKI?
NSAIDs and ACE-Is
What are three causes of intrinsic renal AKI?
renal ischemia
sepsis
nephrotixins
What are nephrotoxins that may cause intrinsic renal AKI?
Abx (vanco/aminoglycosides)
IV contrast
Cisplatin
HIV meds
IVIG
Mannitol
Three major risk factors for ATN caused by IV contrast
renal dz
volume depletion
repeat dosing
What are the two mechanisms by which contrast can cause AKI?
tubular epithelial toxicity
medullary ischemia from vasoconstriction
What are 4 prevention factors for IV induced AKI?
hydration
low osmolal agents at low doses
avoid repeat dose
avoid nephrotoxics for 48 hours after
A decreased GFR without intrinsic renal disease requires what kind of obstruction?
bilateral
Post-renal AKI is often caused by what three things?
Prostate disease
Mets
neurogenic bladder
urine output of > 400mL/24 hours…
nonoliguric
urine output of < 400 mL/24 hours
oliguric
Urine output < 50 to 100mL/24 hours
anuric
Labs for AKI…
UA, CMP + CR/BUN, GFR, FENa
Imaging for AKI…
Renal US
Is biopsy used for AKI?
yes