Acute Kidney Injury

what are 3 parts of the definition for acute kidney injury (AKI)?

-increased SCr by >/= 0.3 mg/dL within 48 hr

-increased SCr to >/= 1. 5 x baseline within 7 days

-decreased urine output to 0.5 mL/kg/hr for 6 hr

what are 2 aspects of the presentation of AKI?

-asymptomatic

-functional signs and symptoms include fluid overload, electrolyte accumulation, and uremia

what are the 3 main causes of prerenal AKI?

-hypovolemia or effective hypovolemia

-medications (NSAIDs, ACE inhibitors, ARBs)

-elevated renal venous pressure

what are the 2 main diseases leading to intrinsic vascular AKI?

-small vessel disease

-large vessel disease

what are 4 causes leading to intrinsic glomerular AKI?

-idiopathic

-medications

-systemic rheumatologic disease

-paraneoplastic syndrome

what are 3 causes of acute tubular necrosis (ATN)?

-ischemia

-medications

-sepsis

what are 4 types of intrinsic tubular interstitial AKI?

-acute tubular necrosis (ATN)

-acute interstitial nephritis (AIN)

-cast nephropathy

-urate nephropathy

what are the 2 main causes of postrenal AKI and what do they have in common?

prostate disease and malignancy are both obstructive

what are 5 factors of AKI evaluation?

-history

-physical examination

-laboratory tests

-urinalysis

-radiography and biopsy

what are 4 main differences between prerenal and acute tubular necrosis?

-prerenal: FENa < 1%, responsive to fluids, oliguria, and BUN/SCr > 20

-ATN: FENa > 2%, unresponsive to fluids, oliguria or nonoliguria, BUN/SCr 10-15

what are 4 factors that suggest a nephritic pattern of glomerular disease?

-RBC and WBC casts in sediment

-variable proteinuria

-HTN

-systemic inflammation

what are 4 factors that suggest a nephrotic pattern of glomerular disease?

-normal sediment

-massive proteinuria

-hypoalbuminemia

-edema

what are 4 signs of acute interstitial nephritis (AIN)?

-rash

-fever

-eosinophilia

-WBC and RBC casts in sediment

what are 4 indications for urgent RRT?

-severe metabolic acidosis with hypervolemia

-severe hyperkalemia, over 6.5 mEq/L

-pulmonary edema

-uremic encephalopathy, seizures, or pericarditis

what are 4 complications for urgent RRT that must be managed?

-volume abnormalities

-electrolyte imbalances

-acid base disturbances

-uremic symptoms

what 2 drug types lead to afferent vasoconstriction?

-NSAIDs

-cyclosporine, tacrolimus

what 2 drug types lead to efferent vasocontriction?

-ACE inhibitors

-ARBs

what are 3 vascular complications that can occur in AKI?

-thrombosis

-vasculitis

-cholesterol emboli

what are 5 drug types that can lead to ATN?

-aminoglycosides

-vancomycin

-amphotericin B

-contrast media

-cisplatin

what are 5 dosing adjustments for aminoglycosides during AKI?

-use once daily dosing

-limit dose and duration

-monitor PK

-avoid concurrent nephrotoxic antimicrobials

-avoid hypovolemia

what are 3 dosing adjustments for vancomycin?

-limit dose and duration

-monitor PK

-avoid concurrent nephrotoxic antimicrobials

what are 4 dosing adjustments for amphotericin B?

-prefer liposomal or lipid complex formulations

-provide daily hydration

-limit cumulative dose

-avoid concurrent nephrotoxic antimicrobials

what are 3 dosing adjustments for contrast media?

-prefer low osmolality agents

-limit dose

-hold other nephrotoxic medications before use, especially metformin

what are 4 dosing adjustments for cisplatin?

-provide pre and post dose hydration

-consider hypertonic saline

-consider mannitol or furosemide

-consider amifostine

what are 4 drug types that can lead to osmotic nephrosis?

-immune globulin

-mannitol

-hetastarch

-dextran

what are 5 drug types that are involved in AIN?

-antimicrobials

-diuretics

-NSAIDs

-PPIs

-anti epileptics

what are 2 drug classes that can lead to tubular obstruction?

-chemotherapy agents

-HMG CoA reductase inhibitors