Kidney Conditions 2

AKI

characterized by a sudden onset and a usually reversible decrease in kidney function​​​​​​​.​​​​​​​

Prerenal AKI

Reduced blood flow to kidney’s, resulting in decreased GFR without structural damage to kidney tissue

• Fluid depletion (N/V/D)

• NSAIDs, ACE inhib, ARBs, cyclosporine

• Heart failure

• Cirrhosis

Intrarenal AKI

damage to the functional part of the kidney, the parenchyma. Usually occurs w/tubular necrosis

• Nephrotoxic agents or meds (aminoglycosides)

• Contrast dyes

• Extended pre-renal failure

• Lupus

• Fat emboli

• Rhabdomyolysis

Acute Tubular Necrosis

Most common cause of AKI w/intrarenal causation

• Renal tubules are damaged and begin to die and GFR decreases

• Preceded by sepsis and acute ischemic event or a toxic event due to a nephrotoxic mechanism.

  • vancomycin, or nephrotoxic agents, such as contrast dye.

Postrenal AKI

the urinary system below the kidney preventing the urine from draining, such as in an obstruction in the urinary tract….increases intra-tubular pressure and decreases GFR.

• enlarged prostate

• masses

• clots or calculi

• neurogenic bladder

AKI Risk Factors

• Hospitalization

• Vancomycin

• Contrast dyes

• NSAIDs

• Aminoglycoside use

AKI Comorbidites

• T1DM and T2DM

• HTN

• Hyperlipidemia

• COVID-19

• HF

• MI

AKI Sx

• Oliguria (decreased urine output)

• Fluid retention

• Edema

• SOB

• HTN

• Arrhythmia

• Hypovolemia sx (hypotension, tachycardia, dizziness)

AKI Labs

• Creatinine

• GFR

• BUN (increased)

AKI Education

• Disease process, potential causes, management of clinical manifestations, diagnostic studies, and treatment strategies such as hemodialysis or peritoneal dialysis, as well as prevention.

• Adequate hydration + fluid restrictions

• Limit potassium, sodium, and phosphorus

• Med education

AKI Tx

• Fluid Challenge (confirms post renal cause)

• Limit potassium

• Hemodialysis

• Furosemide

• ​​​​​​​Sodium polystyrene sulfonate (for potassium)

• Beta-2 agonists such as albuterol (Salbutamol) work together with insulin and glucose to lower serum potassium levels

Nephrotoxic Meds

• Vancomycin

• Tetracycline

• Pantoprazole

• Omeprazole

• Methotrexate

• Lithium

• Cortisone

• Cimetidine

• Aspirin 

• Allopurinol

• Acetaminophen​​​​​​​