Acute Kidney Injury

• Acute Kidney Injury


  sudden and reversible loss of kidney function
• Causes of AKI

  Prerenal - Decreased blood flow to kidneys
• Causes of AKI

  Intrarenal or intrinsic - Direct damage to kidneys
• Causes of AKI

  Postrenal - Obstruction of urine flow
• Causes of AKI

  Postrenal - Anatomy: Involves Urethra and Bladder
• Causes of AKI

  Prerenal - Anatomy: Renal Artery
• Causes of AKI

  Intrarenal - Anatomy: Kidney
• Causes of AKI

  Intrarenal - e.g. Antineoplastic medications, Glomerulonephritis, Rhabdomyolysis
• Causes of AKI

  Prerenal - e.g. Dehydration, Liver cirrhosis, Hemorrhage, Heart failure, Burns
• Causes of AKI

  Postrenal - e.g. Renal calculi, Bladder cancer, BPH
• Phases of AKI

  Clinical Manifestations: Oliguric

  • When: 8-15 days
  • Last for: 1-3 weeks
  • Urine Amount: <30ml/hr or <400ml/day
  • S. Creatinine & BUN: High
  • GFR: Low
  • Potassium: High
  • Calcium: Low
  • Acid-base imbalance: Metabolic Acidosis
  • Increased Urea: Uremia
  • Increased nitrogen: Azotemia
• Phases of AKI

  Clinical Manifestations: Diuretic

  • Urine Amount: 4-5L/day
  • Lasts for: 1 week
  • S. BUN & Creatinine: Decreased
  • GFR: Increased
  • Na: Decreased
  • Potassium: Decreased
• Phases of AKI

  Clinical Manifestations: Recovery

  • When: 1-2 years
  • Labs: Normal Value
• Remember! If the question does not specificy the phase of AKI, refer to oliguric phase
• AKI: Management (Electrolyte Control)

  For hyperkalemia

  • low potassium diet
  • Kayexalate
  • Calcium Gluconate

  For Metabolic Acidosis

  • Sodium Bicarbonate

  For hypocalcemia

  • calcium salts and vitamin D supplement

  For hyperphosphatemia

  • aluminum hydroxide (amphogel), a phophate-binder which enhances excretion of phosphate through the GI tract)
• AKI: Management

  Diet:

  • high calorie
  • high carbohydrates
  • low protein
  • low sodium
  • low potassium
• Uremic fetor is a urine-like odor on the breath of people with uremia.

  • NI: oral hygiene
• Uremic frost is a manifestation of severe azotemia where tiny, yellow-white urea crystals deposit on the skin, resulting in a frosted appearance as sweat evaporates.

  • NP: Skin Integrity