SEPSIS ASSOCIATED ACUTE KIDNEY INJURY Flashcards
(16 cards)
What is the definition of SA-AKI?
AKI in the setting of sepsis based on AKIN or KDIGO criteria.
Sepsis is defined as a life-threatening organ dysfunction due to infection.
What are the epidemiological statistics related to sepsis in ICU patients?
Sepsis occurs in 8.2% to 35.3% of ICU patients, with an increasing prevalence but decreasing mortality rates (18% to 25%).
40% to 50% of ICU patients with AKI have concomitant sepsis.
What is the incidence of AKI in different severities of sepsis?
Incidence increases with sepsis severity:
* Sepsis: 4.2% AKI
* Severe Sepsis: 22.7% AKI
* Septic Shock: 52.8% AKI
Percentages of patients requiring dialysis also increase with severity.
What are the criteria for diagnosing severe sepsis?
Sepsis + organ dysfunction, hypotension, or hypoperfusion.
Severe sepsis indicates a more critical condition than sepsis alone.
What are the hemodynamic factors contributing to AKI in sepsis?
Factors include:
* Decreased peripheral vascular resistance
* Maldistribution of tissue blood flow
* Microcirculatory abnormalities
These abnormalities lead to inadequate kidney perfusion.
What are common urinary findings in AKI due to sepsis?
Variable fractional excretion of sodium and urinary osmolality; common finding includes granular (‘muddy brown’) casts.
These findings can help in diagnosing AKI.
What initial fluid is recommended for fluid management in SA-AKI?
Normal saline is the initial fluid of choice.
Starch solutions should be avoided due to increased AKI risk.
What is the mortality rate associated with SA-AKI?
Approximately 70% mortality rate.
This is significantly higher compared to 20% for severe sepsis without AKI.
What are the key components of early goal-directed therapy (EGDT) for SA-AKI?
EGDT includes:
* Fluid resuscitation
* Vasopressors to maintain MAP ≥65 mm Hg
* Timely administration of antibiotics.
EGDT may not improve outcomes compared to usual care.
What biomarkers can predict moderate to severe AKI within 12 hours?
Urinary TIMP-2 and IGFBP-7.
These biomarkers are not yet widely adopted in clinical practice.
Fill in the blank: AKI usually develops ______ in sepsis.
early, often within 24 hours of septic shock.
True or False: Recovery of kidney function is higher in septic AKI compared to non-septic AKI.
True.
Patients with preexisting CKD have lower recovery rates.
What is the long-term risk for survivors of SA-AKI?
Long-term risk of chronic kidney disease (CKD).
Survivors may face ongoing kidney issues.
What is a common histopathological finding in SA-AKI?
Acute tubular necrosis (ATN) may be seen, but no consistent pattern exists.
GFR decline often exceeds histologic findings.
What is the relationship between AKI severity (RIFLE criteria) and outcomes?
Higher AKI severity and positive fluid balance are associated with worse outcomes.
RIFLE criteria help classify the severity of AKI.
What is the definition of septic shock?
Severe sepsis + hypotension despite fluid resuscitation.
This indicates a critical state requiring immediate intervention.
