6. Acute Kidney Injury - Sakrani

• AKI clinical finding

  • azotemia - elevated BUN + creatinine
  • uremia - azotemia + clinical signs and symptoms of renal failure
• AKI laboratory finding

  • hyperkalemia - lead to arrythmias
• Pre-renal - hypoperfusion leading to decrease GFR
• Intrinsic renal parenchyma disease

  • acute tubular necrosis
  • interstitial nephritis
  • glomerulonephritis
• Post-renal extrinsic - obstructive uropathy
• Pre-renal AKI - tx: hydrate!
• acute tubular necrosis - exogenous nephrotoxin - MOST TOXIC

  • Aminoglycoside - increase creatinine after use
  • -mycin
• Exogenous nephrotoxin to cause acute tubular necrosis

  • amp B - try to decrease dosage
  • chemotherapeutic - cisplatin **
  • radiographic contrast media - if have preexisting kidney disease such as DM **
• Myoglobinuria - endogenous nephrotoxin causing acute tubular necrosis

  • occur in crush injury - car accidents
  • crush injury - car accidents
  • extreme exercise
  • seizure
• ** Hyperuricemia - endogenous nephrotoxin - acute tubular necrosis

  • tetrad of tumor lysis syndrome
  • hyperuricemia
  • hyperkalemia
  • hyperphosphatemia
  • hypocalcemia
• Management of tumor lysis syndrome

  • intravenous hydration - prevention
  • Goal
  • induce high urine output
  • improve glomerular filtration
  • renal perfusion
• Management of tumor lysis syndrome

  • urine alkalization
  • hypouricemic therapy - allopurinol
• acute tubular necrosis Lab finding

  • urine sediment - muddy brown - pigmented granular casts
• Acute tubular necrosis - management

  • adjust dose and frequency of antibiotic use - same loading dose + lower maintenance dose
• Acute interstitial nephritis

  • cause by beta-lactam antibiotics
  • penicillin
  • cephalosporin
• Acute interstitial nephritis - clinical manifestation

  • fever
  • skin rash
  • peripheral blood eosinophilia
• Glomerulonephritis

  • immune complex deposition - antigen excess over antibody production
  • anti-GBM associated acute GN - good pasture
  • kidney or pulmonary hemorrhage
  • autoantibodies with IV collagen
  • pauci-immune acute GN - vasculitis
  • associated with upper airway, pulmonary + skin
• Glomerulonephritis - clinical finding

  • hypertension
  • edema
  • hematuria
• Glomerulonephritis lab

  • red blood cell cast
  • titer
  • anti-GBM antibodies
  • ANCA
  • C3
  • C4
  • ANAs
• Glomerulonephritis treatment

  • high hose corticosteroid
  • cyclophosphamide
  • plasma exchange or plasmapheresis