“IBCC chapter & cast: Acute Kidney Injury” – Links And Ecerpts

I just listened to the podcast of and reviewed the show notes of the IBCC chapter & cast: Acute Kidney Injury
January 2, 2019 by Dr. Josh Farkas from his Internet Book Of Critical Care

Here is the link to the podcast and here is the link to the chapter.

And here are some excerpts from the chapter;

CONTENTS

Te

more detailed understanding of types & prognosis
  • Prognosis depends on changes in urine output and creatinine (figure above).3  Some specific types bear mention:
  • (1) Isolated oliguria (low urine output with stable creatinine).
    • These patients rarely required dialysis, unless oliguria is profound (Stage 3).
    • This may often represent “pre-renal” renal failure – the kidney is compensating for hypoperfusion by reducing urine output, but is continuing to function adequately.
    • Oliguria should be taken seriously and evaluated adequately.  However, <12 hours of oliguria isn’t necessarily a disaster – especially if the creatinine remains stable.
  • (2) Non-oliguric renal failure (elevated creatinine with normal urine output)
    • The vast majority of these patients (99.7% overall) won’t require dialysis.

causes of AKI

  • Pre-renal:  Disorders of perfusion
    • Shock of any etiology
    • Hepatorenal syndrome
    • Abdominal compartment syndrome
    • Hypertensive emergency
    • Thrombotic thrombocytopenic purpura & hemolytic uremic syndrome
  • Intrinsic renal failure
    • Nephrotoxic medications (listed below)
    • Cellular lysis (rhabdomyolysis, hemolysis, tumor lysis syndrome)
    • Acute glomerulonephritis
    • Acute tubulointerstitial nephritis (ATIN)
    • Acute tubular necrosis (ATN)
  • Post-renal:  Urologic obstruction
    • Prostate obstruction
    • Occluded or malpositioned Foley catheter
    • Nephrolithiasis
common nephrotoxins [See Chapter Text]

tests to evaluate the cause of AKI

AKI panel:  tests to order
  • Electrolytes (including Ca/Phos/Mg)
  • Creatinine Kinase [See my Rhabdomyolysis Post]
  • Urinalysis
    • Interpretation shown above.
    • If urinalysis suggests glomerulonephritis or acute interstitial nephritis, consult nephrology to review the urine microscopy and consider renal biopsy.
  • Additional labs if indicated
    • Relevant drug levels (e.g. vancomycin, aminoglycoside, cyclosporine, tacrolimus)
    • Tumor lysis labs if malignancy (lytes, calcium, phosphate, uric acid)
  • Renal & bladder ultrasound
    • Main role is exclusion of hydronephrosis, but may provide additional information (e.g. scarred or polycystic kidneys).
    • Immediate bedside ultrasonography may expedite diagnosis (don’t forget to look at the bladder).

 

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