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Causes of ATN
Phases of ATN
Initiation phase: This phase is the period from the initial insult
until cell injury occurs. It is characterized by acute decrease in
GFR (90 - 120 mL/min/1.73 m2) to very low levels, with a sudden
increase in serum creatinine and BUN concentrations. This phase
lasts hours to days depending on the cause. Prompt treatment can
alleviate irreversible damage.
Oliguric or anuric phase: This phase lasts 5-8 days in the nonoliguric patient and 10-16 days in the oliguric (< 500 CC of
urine/24 hours) one. The GFR is greatly reduced resulting in high
BUN, elevated serum creatinine, hyperkalemia, and metabolic
acidosis (rapid breathing, confusion, shock or death in severe
cases).
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Heart failure.
Respiratory failure.
Sepsis.
Trauma.
Daily weight and accurate intake and output monitoring. These are
powerful indicators of fluid gains or losses over 24 hours. A 1-kg
weight gain/ day represents 1 liter of additional fluid retention.
Prevention: This is the only truly effective remedy for acute kidney
insult (AKI). Nephrotoxic drugs are avoided in patients with AKI or
chronic kidney disease (CKD). Nonsteroidal antiinflammatory (NSAID)
drugs are avoided in patients with high creatinine levels. Intravascular
contrast dye is delayed, if possible, until the patient is fully rehydrated.
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