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Critically Ill > AKI > Flashcards

AKI Flashcards

1
Q

What must be present to confirm an AKI?

A
  1. SCr increase >/= 0.3 mg/dL within 48 h
  2. SCr increase by at least 1.5 times baseline in 7 days
  3. decrease in volume to less than 0.5 ml/kg/h
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2
Q

What is a stage 1 AKI?

A
  1. SCr increase >/=0.3 OR
  2. 1.5-1.9 fold increase in SCr from baseline OR
  3. <0.5 ml/kg/h for >/= 6-12 h
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3
Q

What is a stage 2 AKI?

A
  1. SCr increase 2-2.9 fold from baseline OR
  2. <0.5ml/kg/h for >/=12h
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4
Q

What is a stage 3 AKI?

A
  1. SCr > 3 fold increase from baseline OR
  2. SCr >/= 4mg/dl OR
  3. need for RRT OR
  4. eGFR <35 in patients < 18 years old OR
  5. anuria >/= 12h
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5
Q

Who made the stages for AKI?

A

KDIGO

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6
Q

How long does it take for SCr to increase after the start of an AKI?

A

1-2 days

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7
Q

What are the causes of a prerenal AKI?

A
  1. hypovolemia
  2. reduced cardiac output
  3. systemic vasodilation
  4. renal vasomodulation/ shunting
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8
Q

What are the causes of an intrinsic AKI?

A
  1. vascular/microvascular
  2. glomerular injury
  3. tubulointerstitium (obstruction)
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9
Q

What are the causes of postrenal AKI?

A
  1. bladder outlet obstruction
  2. ureteral obstruction
  3. kidney stones
  4. swelling of abdomen
  5. cancers
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10
Q

What is a diagnostic tool for differentiating AKI?

A

Fraction Excreted Na (FENA)

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11
Q

What type of AKI has characteristics of low urine sodium and a FENA of <1% ?

A

prerenal

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12
Q

What type of AKI has characteristics of elevated urine sodium and a FENA of 2-3% ?

A

intrinsic

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13
Q

What are clinical presentations of an AKI?

A
  1. decreased urine output
  2. urine discoloration
  3. sudden weight gain
  4. severe abdominal or flank pain
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14
Q

What labs indicate an AKI?

A
  1. elevated BUN
  2. increased SCr
  3. BUN:Cr ratio
  4. FENA
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15
Q

What can alter the accuracy of FENA equation? What should be done?

A
  1. diuretic use
  2. see how long the drug lasts
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16
Q

What is the mechanism of prerenal AKI?

A

decreased renal perfusion usually due to volume depletion

17
Q

What is the mechanism of intrinsic AKI?

A

structural damage to the kidney tissue usually due to ischemia or toxins

18
Q

What is the mechanism of post renal AKI?

A

obstruction of urine flow downstream

19
Q

What is the most common type of hospital/ ICU aquired AKI?

A

intrinsic

20
Q

What FENA, BUN/SCr, specific gravity indicates prerenal AKI?

A
  1. FENA: <1
  2. BUN/SCr : >20 (dehydration)
  3. urine specific gravity: >1.018
21
Q

What FENA, BUN/SCr, specific gravity indicates intrinsic AKI?

A
  1. FENA: >2
  2. BUN/SCr : ~15
  3. urine specific gravity: <1.012
22
Q

What FENA, BUN/SCr, specific gravity indicates postrenal AKI?

A
  1. FENA: variable
  2. BUN/SCr : ~15
  3. urine specific gravity: variable
23
Q

How do we prevent AKIs?

A
  1. review medications for nephrotoxicity
  2. adjust renally cleared meds
  3. optimize hemodynamics
  4. hydration
24
Q

What prevention strategy consistently shows benefit?

A

hydration

25
Q

When should hydration be given to patients receiving contrast dyes?

A

prior to and after receiving contrast dyes

26
Q

What fluids are options to prevent AKI?

A
  1. NS
  2. sodium bicarbonate
  3. plasmalyte
  4. lactated ringers
27
Q

What is the glycemic target for ICU patient?

A

140-180 mg/dL

28
Q

What are nonpharm therapies for AKI?

A
  1. fluid boluses with NS
  2. red blood cell transfusions
  3. elimination of meds associated with kidney damage
  4. electrolyte management
  5. improve cardiac output
  6. RRT
29
Q

What are treatments to manage fluid overload?

A
  1. IV loop diuretics
30
Q

What is the mechanism of diuretic resistance?

A

1.decreased diuretic secretion into the tubular lumen
2. severe hypoalbuminemia

31
Q

What are treatment options for diuretic resistance?

A
  1. high dose IV bolus doses
  2. continuous infusion of diuretics
  3. 25% albumin and loop
  4. loop and thiazide
32
Q

What are the indications for RRT?

A

A: acid/base abnormality
E: electrolyte imbalance (hyperkalemia, hypermagnesemia)
I: intoxications
O: fluid overload
U: uremia

33
Q

What drugs can lead to RRT?

A
  1. salicylates
  2. lithium
  3. methanol
  4. ethelyne glycol
  5. theophylline
  6. phenobarbitol
34
Q

The use of what fluids are associated with having proinflammatory effects and can activate leukocytes if used for fluid management of AKI?

A

LR

Critically Ill (20 decks)

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