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AKI Definition
Stage of AKI:
I. Pre-renal injury
In pre-renal failure, the renal tissue is intact and
kidney biopsy shows normal renal histology. Oliguria
and high serum creatinine are due to functional
impairment; since there is no sufficient blood
reaching the kidney to be cleared of these toxins.
Combination of hypotension, hypovolaemia
resulting in diminished renal perfusion is the most
common cause of acute renal failure in hospitalized
patients.
B- Fluid Loss
Gastrointestinal (vomiting or diarrhoea)
Renal (aggressive diuresis or polyuria)
C- Third Space
Haematoma
Illius
Peritonitis
Complications Of AKI:
Cardiovascular
pulmonary odema arrhythmias
hypertension pericardial effusion
myocardial infarction pulmonary embolism
Metabolic
hyponatremia hyperkalemia
acidosis hypocalcemia
hyperphosphatemia
Neurologic:
coma seizures
Gastrointestinal:
gastritis gastroduodenal ulcers
Haematologic:
anaemia hemorrhagic diathesis
Infections
pneumonia septicemia
UTI
Investigations of AKI:
A-Urinary indices:May be helpful in the differentiation
between pre-renal failure and
acute tubular necrosis. Diuretics
should not be given at least during
the preceeding 48 hours for these
parameters to be valid.
B- Urinary sediment:
Centrifugation of fresh urine sample and
examination of the urinary
sediment may be helpful in diagnosing different
causes of ARF
C- Renal Imaging
D-Renal bx.
TREATMENT OF AKI:
A- Treatment of the cause e.g. any
condition causing renal hypoperfusion,
exposure to toxic drug or chemical or
systemic disease.
B- Prevention of AKI:
The timing of intervention to prevent ATN is
important. Protective agents must be
administered at the time of, or immediately
following potential renal insult. This
intervention may prevent or at least blunt
the severity of ATN.
What is CKD?
Epidemiology
CAUSE OF CKD:
Other etiologies
Renovascular disease
Nephrotic syndrome
Hypercalcemia
Multiple myeloma
Chronic UTI
General
Ophthalmologic
AV nicking
HTN
Heart failure
Pericarditis
CAD
Anorexia
Nausea/vomiting
Skin
Cardiac
GI
Pruritis
Pallor
Neurological
MS changes
Seizures
GFR Calculations
Cockcroft-Gault
Men:
Stages of CKD
Management
HTN
Proteinuria
Glucose control
Hypertension
Target BP
<130/80 mm Hg
<125/75 mm Hg
ACEs/ARBs
Diuretics
CCBs
HCTZ (less effective when GFR < 20)
Proteinuria
Microalbuminuria
Macroalbuminuria
Hemoglobin/hematocrit
Bicarbonate
Calcium
Phosphate
PTH
Triglycerides
Metabolic changes
Anemia
Metabolic acidosis
Mineral metabolism
Dyslipidemia
Nutrition
Anemia
Common in CKD
HD pts have increased rates of:
Hospital admission
CAD/LVH
Reduced quality of life
Metabolic acidosis
Muscle catabolism
Sodium bicarbonate
Volume expansion
HTN
Mineral metabolism
Renal osteodystrophy
Calciphylaxis and vascular calcification
Dyslipidemia
Triglycerides
Total cholesterol
Nutrition
Catabolic state
Anorexia
Decreased protein intake
CV disease
Blood
Urine
Urinalysis with
microscopy
Spot urine for
microalbumin
24-urine collection
for protein and
creatinine
Ultrasound
Key points
<130/80 mm Hg
<125/75 mm Hg in proteinuria