AKI Flashcards
What is AKI?
Acute Kidney Injury
abrupt decline in kidney function in 7 days or less
What is AKD?
Between 7 and 90 days after an AKI event before CKD
AKI Stage 1 Scr
1.5 - 1.9 times baselines
OR
>/= 0.3 mg/dl increase
AKI Stage 1 UO
< 0.5 ml/kg/hr for 6 - 12 hours
AKI Stage 2 SCr
2.0 - 2.9 times baseline
AKI Stage 2 UO
<0.5 ml/kg/hr >/= 12
AKI Stage 3 SCr
3.0 times baseline
OR
>/= 4.0 increase
OR
Initiation of renal replacement therapy
OR
In pts <18 y/o dec in GFR <35MLMIN
AKI Stage 3 UO
<0.3 ml/kg/hr FOR >/=24 hrs
OR
Anuria for >/= 12 hrs
AKI Functional Damage
- Increase in biomarkers (SCr, BUN)
- Change in glomerular/tubular function
- Absence of true damage to kidney
AKI Kidney Damage
- Presence of glomerular/tubular injury
- Identified by novel biomarkers
- NGAL (proximal tubule)
- TIMP2 and IGFBP7 (cell cycle arrest)
- KIM 1 (proximal tubule)
Risk Factors of AKI
- Age >65 years
- African American ethnicity
- CKD
- DM
- Nephrotxin use
- Decreased effective circulatory volume (HF, cirrhosis, blood loss)
Gen Prevention of AKI
- Maintain euvolemia and normal Elytes
- isotonic crystalloids
- balanced crystalloids maybe vs saline
- Maintain organ perfusion (MAP > 65 mmHg)
- Vasopressors
- Avoid nephrotoxins
- Aminoglycosides, amphotericin, iodinated contrast, vancomycin, etc)
Prevention of Contrast Induced AKI
- Isotonic Na containing crystalloids
- 1 ml/kg/hr 12 hrs prior and post - Na bicarbonate (harm potential)
- N-acetylcysteine (mod data;no benefit)
- Vitamin D
***Decreasing data
Diuretics in AKI
- No benefit
- To manage edema or HyperK
- Resistance common
- increase dose
Dopamine in AKI
- Increase renal blood flow and urine output
- “renal dose dopamine” - 1 - 3 mcg/kg/min
- No change in AKI outcome
- Increases risk of arrhythmias and hypotension
Fenoldapam
Oral dopamine receptor agonist studied and shown no benefit with increased risk of hypotension
AKI Treatment (Supportive Care)
Maintain fluid, elytes, acid/base homeostasis
BP management
Avoid nephrotoxic meds
Kidney replacement therapy
Nutritional support
Treatment of hemodynamic AKI
Intravascular volume repletion
(Goal: >0.5 ml/kg/hr)
Temp hold meds: ACEi/ARB/NSAIDs/SGLT2is, calcineurin inhbitors
(Restart when kidney back baseline)
Diagnosis of Pre-Renal AKI
FeNa <1%
OR
FeUrea <35% (on loop diuretic)
Treatment of Pre-Renal AKI
Intravascular volume repletion
(Goal: >0.5 ml/kg/hr)
Temp hold meds: Thiazide and loop diuretics
(Restart when kidney back baseline)
Treatment of Intrinsic AKI
If med caused - stop med and DO NOT RESTART
Glomerulonephritis
Acute Tubular Necrosis
Tubulointerstitial nephritis
Vasculitis
Glomerulonephritis Treatment
Immunosuppresion
Acute Tubular Necrosis Treatment
Supportive Care
Tubulointerstitial nephritis Treatment
Glucocorticoids
- Prednisone 0.5 - 1 mg/kg/day x 3-8 weeks then taper
