W2L3 Acute Kidney Injury

Question 1

Nephron is?

Answer 1

Urine producing part of kidney

Question 2

Renal fx?

Answer 2

Excretory fx

• remove excess fluid
• remove waste product
• regulate electrolyte

Secretory fx

• renin
• EPO
• vit D

Question 3

Definiton ARF?

Answer 3

Clinical syn. char by rapid reduction inrenal excretory fx

Question 4

AKI stages?

Answer 4

Classification

• Risk
• Injury
• Failure

Outcome

• Loss
• ESRD

Question 5

AKI defined as?

Answer 5

Increase SCr >0.3mg/dl(24H)

Or

Increase SCr >1.5x baseline(7day)

Or

Urine volume <0.5 ml/kg/h(6H)

Question 6

Epidemiology AKI?

Answer 6

• 5–7% acute care hospital admissions
• 30% to ICU( mortality >50%.)
• Developed nations AKI is almost hospital-acquired

Question 7

Causes AKI?

Answer 7

• Pre-renal(55-60%)

• intravascular volume depletion
• decrease CO(CHF)
• systemic vasodilation

• Intrisic renal(35-40%)
-toxin

•Post-renal(5%)
-acute obs urine flow

Question 8

ICU vs. Non-ICU AKI?

Answer 8

• Non-ICU AKI (only kidney failed organ)(mortality up to 10%)
• ICU AKI associated with sepsis & non-renal multi-organ system failure(mortality >50%)

Question 9

Diagnosis AKI?

Answer 9

1. History and Physical examination:
   -Pre-renal:
   ➢History: vomiting, diarrhea, medications (diuretic, NSAIDs)
   ➢Examination : tachycardia, reduced jugular venous pressure
   -Post- Renal:
   ➢Colicky flank pain->groin (acute ureteric obstruction)
   ➢ Nocturia/frequency/hesitancy (prostatic disease)
2. Review all medications
   - Cause of AKI .
   - Dose Adjustment.
3. Systemic vasculitis with GN:
   • Palpable purpura
   • Pulmonary hemorrhage
   • Sinusitis
4. Atheroembolic
   • Livedo reticularis & signs emboli to legs
5. Rhabdomyolysis.
   • Signs of limb ischemia

Question 10

Blood Tests of AKI?

Answer 10

1. CBC
2. BUN/creatinine
3. Electrolytes
4. Uric acid
5. PT/PTT

Question 11

Urine Analysis AKI?

Answer 11

1. Volume
2. Proteinuria
3. Urinary Indices: FENA & Urinary Sodium
4. Sediments

Question 12

Radiologic AKI?

Answer 12

1. Renal US (obstructive forms)
2. Doppler (assess renal blood flow)
3. CT Scan
4. Pyelography
5. Nuclear Medicine Scans :
   - DMSA: anatomy.
   - DTPA & MAG3: renal fx, urinary excretion & upper tract outflow

Question 13

Complications AKI?

Answer 13

1. Uremia
2. Hyper/Hypovolemia
3. Hyponatremia
4. Hyperkalemia
5. Hyperphosphatemia & Hypocalcemia
6. Bleeding
7. Infections
8. Cardiac Complications.
9. Malnutrition

Question 14

Pre-Renal AKI?

Answer 14

• Prevent & ttt prerenal azotemia (renal perfusion)
• Severe acute blood loss (packed rbc)

Fluids
-isotonic crystalloid over colloid

Vasopressors
-improve kidney perfusion

Cirrhosis & hepatorenal syn.
-albumin prevent AKI

Question 15

Intrinsic Acute Kidney Injury?

Answer 15

1. Diuretic
   - Renoprotective
2. Rhabdomyolysis
   - aggresive volume repletion
3. GN/Vasculitis
   - respond to immunosup agent
4. Aminoglycoside Induced AKI

Question 16

Postrenal?

Answer 16

• Prompt relief of urinary tract obs

Question 17

Indications for Dialysis

Answer 17

A – Acidosis
E – Electrolyte disturb (hyperkalemia)
I – Intoxications (lithium, ethylene glycol)
O – Overload (volume overload)
U – Uremia (symptoms, signs)

Question 18

Modes Of Dialysis?

Answer 18

Hemodynamically stable(IHD)

Hemodynamically unstable

• CRRT
• PD
• SLED (Slow Low-efficiency dialysis)

Question 19

Prognosis?

Answer 19

1. Pre&Post-renal better prognosis
2. Kidneys may recover even after dialysis requiring AKI
3. 10% require dialysis develop ckd.
4. Die early even after kidney function recovers completely