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.

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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.

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Hx DDx.

Pre- Renal Post- Decrease effective arterial volume i.e.

Hypovolemia e.g.Impaired cardiac contract. e.g.Systemic vasodilatation e.g.

Renal vasoconstriction e.g.

Large vessel pathology e.g.

Tubular (ATN) i.e.Ischemia i.e.Toxins:

• Drugs e.g.• Protein e.g.• Pigments e.g.• Crystals e.g.

CIAKI

Intrensic (AIN) i.e.Allergy e.g.Autoimmune e.g.Infection e.g.Infiltration e.g.

Small vessels pathology e.g.

Glomurulonephritis e.g.

Bladder neck e.g.

Ureteral (bilaterally) pathology e.g.

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Px1. 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?

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x.sI

What & Why ??

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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

InterpretationIx.s

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Management & Treatment• Treat underlying disorder, ? steroids if AIN.

• Avoid nephrotoxic insults; review dosing of renally cleared drugs.

• Optimize hemodynamics (both MAP & CO); may take 1–2 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. 1⁄2 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.

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Case

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Extra notesRIFLE classification BUN vs. SCr

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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

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Thank youDone by .. Emad A. Kelantan on 25/11/2012

25-Nov-12