AKI - Zhang

Pathophysiology of pre-renal AKI

Renal blood hyperfusion → renal artery, segmental branches, interlobar vessels, arcuate arteries, interlobular arteries, afferent arterioles, efferent arterioles

Pathophysiology of intrinsic AKI

Ischemic or toxins → Glomerulus, tubules, interstitial tissue, peritubular vasculature

Pathophysiology of postrenal AKI

Obstruction in urine flow → collecting ducts, minor calices, rena pelvis, ureter, bladder, urethra!

Causes of prerenal AKI

NSAIDs, ACEI/ARBs, calcineurin inhibitors

Causes of intrinsic AKI

ATN nephrotoxins like contrast dye and endogenous toxin

Causes of postrenal AKI

Prostatic hypertrophy

Diagnosis of prerenal, intrinsic, postrenal AKI

DOC for AKI treatment - Loop diuretics

MOA: inhibit NKCC2 in thick ascending limb of loop of henle 

Side effects:

1. Electrolyte imbalance

2. Metabolic alkalosis

3. Hyperuricemia

4. Ototoxicity

5. Allergies/other reactions

Loop diuretic comparisons

Predictable oral bioavailability: torsemide and bumetanide > furosemide

Potency: bumetanide > torsemide > furosemide 

Allergy to sulfa drugs: ethacrynic acid 

Loop vs thiazides