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26 Cards in this Set
- Front
- Back
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Define AKI (acute kidney injury)
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Same as renal failure
Decrease in renal function over short period of time (hours to weeks) Possible 50% rise in SCr above baseline Possible 50% dec in GFR Possible need for dialysis Typically reversible More likely to get AKI when you very sick |
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List at least 3 risk factors for AKI
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Preexisting kidney disease
Dehydration (can actually cause AKI) Nephrotoxic drugs (eg contrast media) others: Advanced age Cardiovascular disease Pulmonary disease Acute infection |
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List at least 2 symptoms of AKI
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Most are asymptomatic
Possible low/no urine output others: Malaise Edema HTN Ab pain Encephalopathy(eg confusion, delirium) |
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What are the categories of AKI?
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Pre-renal AKI
Intrinsic AKI Post-renal AKI |
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What are the subcategories of Intrinsic AKI?
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Acute Tubular Necrosis
Acute Interstitial Nephritis Acute Glomerulo-nephritis |
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Whats Acute Tubular Necrosis?
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AKI due to damaged kidney tubules (caused by either ischemia or nephrotoxins)
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Whats Acute Interstitial Nephritis?
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AKI due to inflammatory cells in and around the tubules
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Whats Acute Glomerulo-nephritis?
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AKI due to glomerular membrane damage caused by immune complexes
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What is the main cause of Pre-renal AKI?
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Decreased renal perfusion due to dec'd blood volume or occlusion of the renal arteries
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List some drugs that can cause Pre-renal AKI, and how
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Drugs that constrict the afferent arterioles:
Prostaglandin inhibitors such as NSAIDs and COX2-i's Cyclosporin Drugs that dilate the efferent arterioles: ACE-i's ARBs |
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Whats the most common cause of AKI in inpatients, and in outpatients?
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Inpatients: Intrinsic AKI
Outpatients: Pre-renal AKI |
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List at least two causes of Acute Glomerulo-nephritis
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Autoimmunity diseases:
Goodpasture's syndrome Wegener's granulomatosis Lupus Drugs: Penicillins Thiazides Rifampin Cocaine |
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What are the symptoms of Acute Glomerulo-nephritis?
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Proteinuria
Hematuria Fever, rash, arthritis |
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List at least 3 causes of Acute Tubular Necrosis
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Disorders that cause ischemia:
Hypotension Cardiopulmonary arrest Sepsis Prolonged Pre-renal AKI Nephrotoxins: Radiocontrast media Aminoglycosides Amphotericin B Cisplatin |
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What is CIN?
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A type of Acute Tubular Necrosis
Contrast Induced Nephropathy Acute dec in renal function due to IV radiocontrast media |
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What is the main indication of CIN?
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25%+ increase in SCr
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What kidney problems can diuretics cause/exacerbate?
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Pre-renal AKI
CIN |
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List at least 3 methods to prevent CIN
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Sodium volume loading
Acetylcysteine Sodium bicarbonate Aminophylline Theophylline Dopamine Mannitol |
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Whats the regimen for sodium volume loading?
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1/2 or full normal saline
100cc/hour or 1ml/kg/hr Start 12 hours before die administration and continue for 12 hours after |
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Whats the regimen for acetylcysteine?
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600mg bid the day before and the day of dye administration (4 doses total)
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Whats the regimen for sodium bicarbonate?
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D5W + 154mEq NaHCO3/L
3ml of this soln per kg for 1 hr prior to procedure And 1ml/kg/hr for 6hrs after procedure |
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What are the symptoms of Acute Interstitial Nephritis?
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Fever
Rash Eosinophilia |
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List at least 3 general causes of Acute Interstitial Nephritis
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Drugs
Malignancy Infection Systemic diseases(lupus, sarcoidosis) Idiopathic "you missed/miisd it because your aim/AIN was off" |
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List at least 3 drug induced causes of Acute Interstitial Nephritis
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Penicillins
Cephalosporins Sulfonamides Rifampin Phenytoin Furosemide NSAIDs PPIs "aiming/AINing PP PRiCkS is FuN" |
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What is the main cause of Post-renal AKI?
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An obstruction located anywhere from the renal tubules to the urethra
This can include emboli, stones, crystals, tumors, or BPH "its BEST not to have Crystals stuck in your urethra" |
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What drug(s) can cause Post-renal AKI?
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Anticholinergics(constricts the urethral sphincter iblv)
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