AcuteKidneyInjury-MiniLecture.pptVIP

TEACHING · RESEARCH · PUBLIC SERVICE Click to edit Master title style Acute Kidney Injury - Mini Lecture Updated 02/2013 Quickly and easily identify and workup acute kidney injury. Objectives The incidence of AKI is estimated at 1% of patients that present to the hospital and 7-50% of patients in the ICU. Part of the initial history should be determining every patients baseline Cr. May present as Uremia (malaise, anorexia, nausea, vomiting), but is usually asymptomatic. Acute Kidney Injury Network (AKIN) Criteria Background Stage Cr Criteria UOP Criteria 1 Cr↑by 1.5-2x baseline or Cr↑by 0.3 mg/dl 0.5 ml/kg/hr for 6hr 2 Cr↑by 2-3x 0.5 ml/kg/hr for 12hr 3 Cr↑by more than 3x or Cr↑by 0.5 if baseline 4mg/dl 0.3 ml/kg/hr for 24hr Or anuria for 12h AKI can be Prerenal, Intrinsic or Postrenal Acute Kideny Injury Prerenal Uosm 5000 mosm/kg Una 20meq/L FEna 1% Microscopy - bland Intrinsic Renal Diseases Postrenal Uosm: variable Una: low early, high late FEna: variable Microscopy - bland Ischemic / Toxic ATN Uosm ~ 300 mosm/kg Una 40meq/L FEna 2% Microscopy – dark pigment cast Acute Interstitial Nephritis Uosm: variable, ~300 mosm.kg Una 40 meq/L FEna 2% Microscopy – leukocytes, erythrocyts, leukocyte casts Acute Glomerulonephritis Uosm: variable (400 in early GN) Una: variable (20meq/l in early GN) FEna: variable, 1% in early GN Microscopy – hematuria, proteinuria Erythrocyte casts (dysmorphic) Prerenal azotemia is the most common cause of acute kidney injury in the outpatient setting Look for patients with decreased PO, diarrhea, vomiting, tachycardia, orthostasis…. Order: UA, Uosm, Una, Ucr, BMP, Uurea (if on diuretics) The kidney functions properly in patients with prerenal azotemia. True volume depletion can be treated with normal saline. Decreased effective arterial blood volume can be present in CHF, Cirrhosis or nephrotic syndrome. Treatment should focus on the underlying disease. Prerenal Az