Acute kidney injury :

definition :
KDIGO criteria : either:
1. >0.3 mg / dl increase in SCr within < 48hrs.
2. >1.5 fold increase in SCr within <7 days
3. <0.5 ml/kg/hr urine output for > 6 hrs.
ETIOLOGIES :
1. Prerenal azotemia :
is the most common cause of AKI
accounts for approximately 60
causes:

Mechanism Condition

Intravascular volume depletion and Hemorrhage; gastrointestinal, renal, and

hypotension dermal losses

Decreased effective intravascular volume Congestive heart failure, cirrhosis,

hepatorenal syndrome, peritonitis

Systemic vasodilation/renal vasoconstriction Sepsis, hepatorenal syndrome

Large-vessel renal vascular disease Renal artery thrombosis or embolism,

intraoperative arterial cross-clamping, renal
artery stenosis, cholesterol emboli

Small-vessel renal vascular disease Sepsis, vasculitis, atheroembolism,

hemolytic-uremic syndrome, malignant
hypertension, scleroderma, preeclampsia,
sickle cell anemia, hypercalcemia, transplant
rejection

Impaired renal blood flow Cyclosporine, tacrolimus, ACEIs, ARBs,

NSAIDs, radiocontrast agents

2. renal azotemia:
causes : injury to :
A. tubules, ( acute tubular necrosis (ATN) )
a. ischemic : most common : SAME CAUSES OF PRE-RENAL AZOTEMIA
b. toxins in patients who are :
elderly ,
 diabetic,
hypotensive ,
with a reduced effective arterial volume
toxins includes :
Aminoglycosides
Radiocontrast agents
Acyclovir
Cisplatin
Sulfonamides
Methotrexate
Cyclosporine
Tacrolimus
Amphotericin B
Methotrexate
Foscarnet
Pentamidine
Ethylene glycol
Toluene
Cocaine
HMG-CoA reductase inhibitors
B. interstitium, ( acute interstitial nephritis (AIN) )
a. medications include :
-LACTAM ANTIBIOTICS
1. Penicillin
2. Cephalosporins
3. Ampicillin
4. Methicillin
5. Nafcillin
DIURETICS
1. Furosemide
2. Hydrochlorothiazide
3. Triamterene
OTHER ANTIBIOTICS
1. Sulfonamides
2. Vancomycin
3. Rifampin
4. Acyclovir
5. Indinavir
6. NSAIDS
7. Ibuprofen
8. Naproxen
9. Indomethacin
b. Bacterial and viral infections
 c. kidney-confined or systemic autoimmune process.
systemic lupus erythematosus,
Sjgren's syndrome,
cryoglobulinemia,
primary biliary cirrhosis
C. vasculature,
D. glomerulus