Acute kidney injury

Acute kidney injury

1. lab markers

   • decr. GFR
     • decr. Creatinine clearance
       • **incr Creatinine
         • if rises 1-1.5x norm
     • around 1 is norm

2. prerenal

   • Shock
     • hypovolemic
       • treat the shock
       • not getting enough bld to kid
     • any shock
     • oliguric
       • **low urin Na+ (<20meq/l)
       • BUN/Cr high >20x

3. Renal

   • Glomerulonephritis
     • gets inflamed
     • immune response
       • post-strept GN
         • ( PSGN)
           • few weeks post strep
     • clinical
       • edema, HTN, oligouric
     • labs/ urinalisis
       • **RBC cast
     • Rx
       • steroids, immune suppressants
   • any autoimmune dis.
   • acute tubular necrosis (ATN)
     • **lead cause of AKI
     • Ischemic 90%
       • **Oliguric
         • sepsis, trauma
         • **high urine Na+
           • kidney starting to die so spill Na+
         • BUN/Cr low
       • Rahabdomyolysis
         • causes
           • crush injury
             • OD
               • burns
                 • heat stroke
         • myoglobin plugs tubules
         • labs
           • **no red cells in urine w/ false + in dip
         • Dx
           • rise in CK 5x normal
           • **Creatinine goes up FAST
       • Rx
         • make urine, bridging dialysis
           • IVF
     • Toxic 10%
       • non- oliguric
         • contrast agents
         • toxic alcohols
         • aminoglycosides
         • Myoglobin
     • Rx
       • no contrast
         • hydration
           • lower ionic
             • lower doses
               • lower osmolar agents
                 • N acetylcysteine
                   • mucomist for Tylenol OD
     • risk
       • pre-exist renal dis.
       • elderly
         • dehydrated
           • hypoTN

4. Post renal

   • obstruction
     • most common= enlarged prostate
       • back up in kidney
         • MI from incr. K
     • tumor
     • retro peritoneal bleed
     • stones
   • Dx
     • US/CT = hydronephrosis

5. indications for emergent dialysis

   • refractory volume overload
     • refractory hyperkalemia
       • severe metabolic acidosis
         • severe Na+ acidosis
           • symptomatic uremia
             • Pericarditis, bleeding, encephalopathy
             • Toxins

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