RX-413: Acute Kidney Injury

Therapeutics Exam 4

What does UOP stand for?

Urine output

What does Oliguria mean?

Low urine output

What UOP needs to be met in order to be classified as oliguric?

<500mL/day

What does Anuria mean?

Lack of Urine output.

What UOP classifies as anuria?

<50mL/day

What does RRT stand for?

Renal Replacement therapy (Dialysis)

What are some risk factors for AKI?

CKD, diabetes, cancer, female, trauma, dehydration, anything that will affect your blood, urine, or immune system.

What are 3 hallmarks of acute kidney decline?

Increase of serum creatinine by 0.3 mg/dL within 48 hours.

Increase of serum creatinine >1.5 times baseline occurring within the last 7 days

Urine volume <0.5 mL/kg/h for more than 6 hours.

What does RIFLE stand for

Risk, Injury, Failure, Loss, End-stage renal Disease

What are the SCr and UOP outputs that make someone at risk of AKI (RIFLE)

SCr increases 1.5-1.9 times the baseline, or a decrease in GFR >25%.

OR

UOP <-0.5mL/kg/h in 6 hours. 

What are the Scr and UOP outputs that RIFLE categorizes injury.

SCr increases 2-2.9 times the baseline, or a decrease in GFR by >50%

What are the SCr and UOP that RIFLE categorizes kidkey failure?

SCr >3 times the baseline AND a decrease in GFR by more than 75%

OR

urine output <0.3mg/kg/h for 24 hours or anuria for more than 13 hours.

What does RIFLE categorize Kidney loss?

Persistent renal failure for more than 4 weeks

What does RIFLE categorize end-stage renal disease as?

Persistent renal failure for more than 3 months

What is the difference between end-stage renal disease and kidney loss?

Kidney loss is persistent renal failure for more than 4 weeks, ESRD is persistent renal failure for more than 3 months.

What is the classification of stage 1 AKI?

SCr increase 0.3mg/dL or 1.2 times the baseline. OR UOP <0.5mL/kg/h in 6 hour

What is the classification of stage 2 AKI?

SCr increased 2-3 times the baseline OR UOP <0.5mL/kg/hour for 12 hours

What is the classification of stage 3 AKI?

SCr increase 3 times the baseline, requiring RRT, or UOP <0.3mL/kg/hour for 24 hours or Anuria for more than 12 hours.

What are the 3 classifications of kidney injury?

Pre-renal (Reduced volume or pressure of blood delivered to the kidney)

Intrinsic (Internal damage of the kidney structure)

Post-renal (Damage or blockage of urine outflow)

What are the 4 main lab values we are looking for when assessing AKI?

Urine RBC

Urine WBC

FE

BUN/SCr

What values of Urine RBC, WBC, FE, and BUN/SCr are consistant with Pre-renal Kidney damage?

Urine RBC: None

Urine WBC: None

FE: <1

BUN/SCr: >20

BUN/SCr is the main thing we are looking for in Pre-renal kidney damage.

What values of Urine RBC, WBC, FE, and BUN/SCr are constant with intrinsic kidney damage?

Urine RBC: 2-4

Urine WBC: 2-4

FE: >2

BUN: ~15

Urine blood counts are what we are looking for with intrinsic kidney injury

What values of Urine RBC, WBC, FE, and BUN/SCr are constant with post-renal kidney injury?

Anything that isn’t the other two. It’s really just variable. 

What are the treatments to pre-renal kidney injury?

Stop doing the thing that is hurting your kidney

Fluid replacement (NS)

Hemodynamic support (Vasopressors)

• Things that increase blood pressure to increase blood flow to kidney

What are the 4 types of Intrinsic AKI?

Acute Tubular Necrosis (ATN)

Acute Interstitial Nephritis (AIN)

Glomerular injury 

Vascular injury

How do you treat ATN (Acute tubular necrosis)?

Stop doing the thing that is hurting your kidney

Manage electrolyte imbalance

Diuretic maybe (Furosemide)

Renal Replacement Therapy (RRT/Dialysis)

How do you treat AIN (Acute interstitial nephritis)?

Stop doing the thing that hurt your kidney

Corticosteroids (Prednisone)

How do you treat Post Renal Kidney injury?

Stop doing the thing that hurt your kidney

Remove/relieve obstruction

What are indications for RRT?

Life threatening changes in fluids, electrolytes, or acid-base status

• Acid/base

• Electrolytes

• Intoxicants

• volume Overload

• Uremia 

What type of AKI may require alkalinization of the urine?

Post-renal

Pre-renal

Intrinsic

Post-renal

A patient presenting with severe vomiting and diarrhea, who had lost lots of fluid, would be at risk of which type of AKI?

Pre-renal

Post-renal

Intrinsic

Pre-Renal

An increase in serum creatinine by ___ mg/dL within ____ hours is one of the KDIGO definitions of AKI.

0.3; 48

0.5; 48

0.2; 72

0.7; 72

0.3; 48

The “F” in RIFLE stands for:

Fluid

Failure

Fetal

Final

Failure

Contrast-induced nephropathy (CIN) is a type of which category of AKI?

Post-renal

Pre-renal

Intrinsic

Intrinsic