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Acute kidney injury (aki) final

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Emad Kelantan

This document defines acute kidney injury (AKI) and provides guidance on how to approach a case of AKI. It defines AKI as an abrupt deterioration in renal function over 48 hours seen through increased blood urea nitrogen, creatinine, and oliguria. The approach involves taking a history, performing a physical exam, ordering diagnostic tests such as bloodwork and urine analysis, and managing the underlying disorder, hemodynamics, and complications. Treatment aims to avoid nephrotoxic insults, optimize volume status, and consider dialysis for refractory conditions affecting acid-base, electrolyte, or volume balance.

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Acute Kidney Injury (AKI) Emad A. Kelantan, MBBS Umm Al Qura university, Makkah, K.S.A
Components Definition. Approach: Hx. Px. Ix.s Management & Treatment. Case. Extra notes. 25-Nov-12
Definition AKI is an abrupt ( > 48 h ) deterioration in the renal parenchymal excretory function i.e. 1. BUN !! 2. Creatinine level in the blood: 46 92 micromole/L 0.6 1.2 mg/dl 3. UOP: Oligouria if < 500 ml/24h or < 0.5 ml/kg/h 24h Auria if < 50 ml/24h Azotemia Vs. Uremia?? 25-Nov-12
How to approach AKI? 1. Hx 2. Px 3. Ix.s 4. Management & treatment. 25-Nov-12
DDx. Hx Pre- Renal Post- Decrease effective arterial Tubular (ATN) i.e. Bladder neck e.g. volume i.e. Ischemia i.e. Toxins: Hypovolemia e.g. Drugs e.g. Impaired cardiac contract. e.g. Ureteral (bilaterally) Protein e.g. Systemic vasodilatation e.g. pathology e.g. Pigments e.g. Crystals e.g. Renal vasoconstriction e.g. CIAKI Intrensic (AIN) i.e. Large vessel pathology e.g. Allergy e.g. Autoimmune e.g. Infection e.g. Infiltration e.g. Small vessels pathology e.g. Glomurulonephritis e.g. 25-Nov-12
Px 1. Vitals: ( What each sign indicates? ) T 39.9 C ?? BP 60/40 ?? P 20 bpm ?? O2 saturation 99% ?? RR 20 bpm ?? 2. What other signs you are looking for regarding your DDx? 25-Nov-12
Ix.s What & Why ?? 25-Nov-12
List of Ix.s that should be ordered in AKI CBC. Biochemistry. Urine evaluation: 1. UOP. 2. U/A. 3. U/E. 4. Osmolarity. 5. Sediment. Fractional exertion of Na. Renal U/S. Serology if needed ?? Renal Bx if needed ?? 25-Nov-12
Ix.s Interpretation 25-Nov-12
Management & Treatment Treat underlying disorder, ? steroids if AIN. Avoid nephrotoxic insults; review dosing of renally cleared drugs. Optimize hemodynamics (both MAP & CO); may take 12 wks to recover from ATN Watch for and correct volume overload, electrolyte ( K, PO4), & acid/base status If obstruction is diagnosed and relieved, watch for: Hypotonic diuresis (2 buildup of BUN, tubular damage); Rx w/ IVF (e.g. 12 NS). Hemorrhagic cystitis (rapid in size of bladder vessels); avoid by decompressing slowly. Indications for urgent dialysis (when condition refractory to conventional therapy) Acid-base disturbance: acidemia Electrolyte disorder: generally hyperkalemia; occasionally hypercalcemia, tumor lysis Intoxication: methanol, ethylene glycol, lithium, salicylates Overload of volume (CHF) Uremia: pericarditis, encephalopathy, bleeding No benefit to dopamine (Annals 2005;142:510), diuretics (JAMA 2002;288:2547), or mannitol. 25-Nov-12
Case 25-Nov-12
Extra notes RIFLE classification BUN vs. SCr 25-Nov-12
References Kumar & Clark : Clinical Medicine, 7th edition. Pocket Medicine 4th Edition. FIRST AID for the CASES USMLE STEP2 CK Second Edition. USMLE : Internal Medicine CK 2011. www.Wikipedia.com 25-Nov-12
Thank you Done by .. Emad A. Kelantan on 25/11/2012 25-Nov-12

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Acute kidney injury (aki) final

  • 1. Acute Kidney Injury (AKI) Emad A. Kelantan, MBBS Umm Al Qura university, Makkah, K.S.A
  • 2. Components Definition. Approach: Hx. Px. Ix.s Management & Treatment. Case. Extra notes. 25-Nov-12
  • 3. Definition AKI is an abrupt ( > 48 h ) deterioration in the renal parenchymal excretory function i.e. 1. BUN !! 2. Creatinine level in the blood: 46 92 micromole/L 0.6 1.2 mg/dl 3. UOP: Oligouria if < 500 ml/24h or < 0.5 ml/kg/h 24h Auria if < 50 ml/24h Azotemia Vs. Uremia?? 25-Nov-12
  • 4. How to approach AKI? 1. Hx 2. Px 3. Ix.s 4. Management & treatment. 25-Nov-12
  • 5. DDx. Hx Pre- Renal Post- Decrease effective arterial Tubular (ATN) i.e. Bladder neck e.g. volume i.e. Ischemia i.e. Toxins: Hypovolemia e.g. Drugs e.g. Impaired cardiac contract. e.g. Ureteral (bilaterally) Protein e.g. Systemic vasodilatation e.g. pathology e.g. Pigments e.g. Crystals e.g. Renal vasoconstriction e.g. CIAKI Intrensic (AIN) i.e. Large vessel pathology e.g. Allergy e.g. Autoimmune e.g. Infection e.g. Infiltration e.g. Small vessels pathology e.g. Glomurulonephritis e.g. 25-Nov-12
  • 6. Px 1. Vitals: ( What each sign indicates? ) T 39.9 C ?? BP 60/40 ?? P 20 bpm ?? O2 saturation 99% ?? RR 20 bpm ?? 2. What other signs you are looking for regarding your DDx? 25-Nov-12
  • 7. Ix.s What & Why ?? 25-Nov-12
  • 8. List of Ix.s that should be ordered in AKI CBC. Biochemistry. Urine evaluation: 1. UOP. 2. U/A. 3. U/E. 4. Osmolarity. 5. Sediment. Fractional exertion of Na. Renal U/S. Serology if needed ?? Renal Bx if needed ?? 25-Nov-12
  • 10. Management & Treatment Treat underlying disorder, ? steroids if AIN. Avoid nephrotoxic insults; review dosing of renally cleared drugs. Optimize hemodynamics (both MAP & CO); may take 12 wks to recover from ATN Watch for and correct volume overload, electrolyte ( K, PO4), & acid/base status If obstruction is diagnosed and relieved, watch for: Hypotonic diuresis (2 buildup of BUN, tubular damage); Rx w/ IVF (e.g. 12 NS). Hemorrhagic cystitis (rapid in size of bladder vessels); avoid by decompressing slowly. Indications for urgent dialysis (when condition refractory to conventional therapy) Acid-base disturbance: acidemia Electrolyte disorder: generally hyperkalemia; occasionally hypercalcemia, tumor lysis Intoxication: methanol, ethylene glycol, lithium, salicylates Overload of volume (CHF) Uremia: pericarditis, encephalopathy, bleeding No benefit to dopamine (Annals 2005;142:510), diuretics (JAMA 2002;288:2547), or mannitol. 25-Nov-12
  • 11. Case 25-Nov-12
  • 12. Extra notes RIFLE classification BUN vs. SCr 25-Nov-12
  • 13. References Kumar & Clark : Clinical Medicine, 7th edition. Pocket Medicine 4th Edition. FIRST AID for the CASES USMLE STEP2 CK Second Edition. USMLE : Internal Medicine CK 2011. www.Wikipedia.com 25-Nov-12
  • 14. Thank you Done by .. Emad A. Kelantan on 25/11/2012 25-Nov-12