Exam 5: AKI

Question 1

Name the 2 medications that increase risk/cause nephrotoxicity.

Answer 1

• aminoglycosides (gentamicin, amikacin)

- amphotericin B

Question 2

Name the 5 ways to NON-PHARMALOGICALLY prevent AKI.

Answer 2

• DC meds that increase risk/cause nephrotoxicity
• administer nephrotoxic agents in manner that decreases risk
• Dietary restriction
• Proper care of foley catheter
• optimal fluid intake (2L/day)

Question 3

Name the 2 ways to PHARMACOLOGICALLY prevent AKI.

Answer 3

• KDIGO

- glycemic control via insulin therapy

Question 4

What does KDIGO recommend NOT using? (FLAD)

Answer 4

• Fenoldopam
• Low dose dopamine
• Atrial natriuretic peptide (ANP)
• Diuretics

Question 5

What 4 things can be done to manage PRERENAL AKI?

Answer 5

• physical removal of obstruction
• removal of ACEs, ARBs, NSAIDs (lower RBF- compensatory mechanism)
• fliud replacement (diuretics)
• RED BLOOD CELL transfusion due to blood significant blood loss.

Question 6

What intravenous hydration therapy is used to treat patients w/ PRE-RENAL AKI?

Answer 6

If BP is below 90/60 (Hypotensive) administer a bolus of normal saline: 250 to 500 mL over 15- 30 minutes until signs of volume-depletion improve.
- then administer 100-150 ml/hr until fluid state improves

Question 7

What do we monitor when managing pre-renal AKI and administering fluids?
UB-PEN

Answer 7

UB-PEN
Urine output 
BP (adequate)
Peripheral edema
Electrolyte balance
Normoglycemia

Question 8

When do you initiate intravenous hydration?

Answer 8

BP equal to or below 90/60 Hm mg

Question 9

Which supportive care is preferred in AKI management for treatment of pulmonary edema?

Answer 9

Fluid Management over RRT: renal replacement therapy

Question 10

When is RRT preferred?

Answer 10

When diuretic therapy fails.

Question 11

What LOOP diuretics are used in fluid management in AKI? Route?

Answer 11

Furosemide, bumetanide, torsemide

IV administration

Question 12

What electrolyte abnormalities are seen in AKI electrolyte management? Most common?

Answer 12

K+ (most common)
Na+
PO4
Mg+

Question 13

Name the 5 indications for RRT. (AEIOU)

Answer 13

• Acid-base abnormalities
• Electrolyte imbalance
• Intoxications
• Fluid Overload (not responsive to loops)
• Uremia

Question 14

What 3 medications can cause ACUTE TUBULAR NECROSIS- Tubular Epithelial Cell Damage?

Answer 14

• aminoglycosides
• amphotericin B
• radiocontrast dye (media)

Question 15

What 4 types of medication can cause Hemodynamically -mediated kidney injury?

Answer 15

ACEs
ARBs
NSAIDs
COX-2 inhibitors

Question 16

What 3 types of medication can cause acute allergic interstitial nephritis (Tubulointerstitial Disease)

Answer 16

Penicillins
NSAIDs
COX-2 inhibitors
(intrinsic AKI)