(精编)【持续性肾脏替代治疗CRRT英文精品课件】Acute Kidney Injury （AKI）.pptVIP

* * Immediate + long term therapeutic concerns? Correct metabolic acidosis: Yes or No? HC03 may ppt hypoCa tetany + worsen fluid retention Severe HTN: reduce by 50% over 24 hrs with oral agents. If HBP emergency, give IV nicard, labetalol or nitropusside. Cardiac toxicity (long QT): correct hypoCa After clinical stability, insert HDC for acute dialysis. Chr dialysis: anemia, Vit D def, hyper-P, HBP + PEM Cell degeneration Tamm-Horsfall Protein+EC = Cellular casts Granular casts Hyaline casts = ATN, NS CKD Waxy cast Fine granular AKF Clinical MX: Early (or pre-renal) AKI To prevent late stage AKI prompt fluid tx mandatory forced diuresis + ionotropic supports in CHF Correct fluid deficit + pressor agents in sepsis syndrome repair fluid deficit + hyperglycemia in DKA Restore oncotic pressure (25% alb/ lasix) in severe NS Avoid nephrotoxic agents: NSAID, contrast agents + AG Abx Higher risk of injury in pre-existing KD/ solitary kidney Fluid Mx in early (or pre-renal) AKI Fluid bolus to correct peripheral CF Fluid choice: Crystalloids [NS/ LR]; colloids [alb + dextran] Rehydrate: mild, mod and severe DHN Assess adequacy: MS, PR, BP, CVP + UOP Absent UOP in 2 hrs: examine for bladder distension urethral catheterization if urinary retention If no UOP or bladder distension, and CVP is 5-10 cm forced diuresis with 2-4 mg/kg furosemide. Failure suggests intrinsic AKI Clinical MX: Oliguric late (or intrinsic) AKI Tx modality depends on severity of GFR loss Fluid restriction: replace ongoing + IW losses. Larger fluid requirement during polyuric [recovery] phase Correct MA if pH is 7.1 or s/HCO3 12 mEq/L Avoid rapid correction: hypoCa tetany. If combined hyperK/ MA, correct by infusion of 1 mEq/kg NaHCO3 Forced diuresis confers no renal survival benefit, but improves fluid control + delay dialysis. May increase MR HyperK: albuterol/ [insulin+glucose] stimulate IC uptake Na polystyrene sulfonate resin (1 gm/kg) exc