Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 27 views

    Acute Kidney Injury

    Uploaded by

    yinyangdong
    This document provides an overview of acute kidney injury (AKI), including definitions, etiology, pathophysiology, risk factors, staging criteria, presentation, workup, treatment, and management recommendations. AKI is defined as an abrupt decrease in kidney function and loss of filtration within hours or days. It affects up to 18% of hospital admissions and has a high mortality rate. Prevention efforts could save thousands of lives each year. Causes include reduced blood flow to the kidneys or direct injury. Treatment involves conservative management like fluid balance correction or relieving obstructions, with referral to nephrology as needed.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd

    Acute Kidney Injury

    Uploaded by

    yinyangdong
    27 views21 pages
    This document provides an overview of acute kidney injury (AKI), including definitions, etiology, pathophysiology, risk factors, staging criteria, presentation, workup, treatment, and management recommendations. AKI is defined as an abrupt decrease in kidney function and loss of filtration within hours or days. It affects up to 18% of hospital admissions and has a high mortality rate. Prevention efforts could save thousands of lives each year. Causes include reduced blood flow to the kidneys or direct injury. Treatment involves conservative management like fluid balance correction or relieving obstructions, with referral to nephrology as needed.

    Original Description:

    AKI

    Original Title

    Aki

    Copyright

    © © All Rights Reserved

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document provides an overview of acute kidney injury (AKI), including definitions, etiology, pathophysiology, risk factors, staging criteria, presentation, workup, treatment, and management recommendations. AKI is defined as an abrupt decrease in kidney function and loss of filtration within hours or days. It affects up to 18% of hospital admissions and has a high mortality rate. Prevention efforts could save thousands of lives each year. Causes include reduced blood flow to the kidneys or direct injury. Treatment involves conservative management like fluid balance correction or relieving obstructions, with referral to nephrology as needed.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    27 views21 pages

    Acute Kidney Injury

    Uploaded by

    yinyangdong
    This document provides an overview of acute kidney injury (AKI), including definitions, etiology, pathophysiology, risk factors, staging criteria, presentation, workup, treatment, and management recommendations. AKI is defined as an abrupt decrease in kidney function and loss of filtration within hours or days. It affects up to 18% of hospital admissions and has a high mortality rate. Prevention efforts could save thousands of lives each year. Causes include reduced blood flow to the kidneys or direct injury. Treatment involves conservative management like fluid balance correction or relieving obstructions, with referral to nephrology as needed.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 21

    Acute Kidney

    Injury
    What this presentation covers
     Background
     Definitions
     Etiology
     Pathophysiology
     Management
     Recommendations
    Background
    • Acute kidney injury (previously known as acute renal
    failure) covers a wide spectrum of injury to the
    kidneys, not just kidney failure

    • Up to 18% of all hospital admissions have AKI

    • Inpatient AKI-related mortality is between 25 and 30%

    • Between 20 and 30% of cases of AKI are preventable.


    Prevention could save up to 12,000 lives each year

    • NHS costs related to AKI are between £434 and £620


    million per year
    Definition

     An abrupt (within hours) decrease in


    kidney function, which encompasses
    both injury (structural damage) and
    impairment (loss of function)
     Rapid impairment in renal function
    resulting in raised plasma urea/creatinine,
    fluid and/or acid-base imbalance which
    is reversible

    Makris K. Acute Kidney Injury: Definition, Pathophysiology and


    Clinical Phenotypes. Clin Biochem Rev 37 (2) 2016
    Profound reduction of the blood flow to the outer
    stripe of the outer medulla as indicated in B

    Basile, David P et al. “Pathophysiology of acute kidney


    injury” Comprehensive Physiology vol. 2,2 (2012): 1303-53.
    Risk factors: adults
    • Chronic kidney disease (or history of)
    • Diabetes
    • Heart failure
    • Sepsis
    • Hypovolaemia
    • Age 65 years or over
    • Use of drugs with nephrotoxic potential (for example,
    NSAIDs, ACE inhibitors)
    • Use of iodinated contrast agents within past week
    • Oliguria
    • Liver disease
    • Limited access to fluids, e.g. via neurological impairment
    • Deteriorating early warning scores
    • Symptoms or history of urological obstruction
    Risk factors: children and young people

    As for adults, with the following additional risks:


    • Abnormal or deteriorating paediatric early
    warning score
    • Young age, disability or cognitive impairment with
    dependency on carers for access to fluids
    • Severe diarrhoea, especially bloody diarrhoea
    • Signs or symptoms of nephritis (for example,
    oedema or haematuria)
    • Haematological malignancy
    • Hypotension
    KDIGO criteria

    Makris K. Acute Kidney Injury: Definition, Pathophysiology and


    Clinical Phenotypes. Clin Biochem Rev 37 (2) 2016
    Staging RIFLE Criteria

     Proposed by ADQI

     Severity (Stage 1-3)


     Risk: GFR decrease >25%, serum creatinine increased 1.5 times OR
    urine production of <0.5 ml/kg/hr for >6 hours
     Injury: GFR decrease >50%, doubling of creatinine OR urine
    production <0.5 ml/kg/hr for 12 hours
     Failure: GFR decrease >75%, >tripling of creatinine or creatinine >355
    μmol/l (>4 mg/dl) OR urine output below 0.3 ml/kg/hr for 24 hours
     Outcome
     Loss: persistent AKI or complete loss of kidney function for more than 4
    weeks
     End-stage renal disease: need for renal replacement therapy (RRT)
    for more than 3 months Bellomo R, et.al. Acute renal failure – definition, outcome
    measures, animal models, fluid therapy and information
    technology needs: the Second International Consensus
    Conference of the Acute Dialysis Quality Initiative (ADQI)
    Group. Crit Care. 2004; 8(4): R204–R212.
    Etiology
    • Pre renal
    prerenal etiologies account for 25–
    60%

    • Renal
    renal etiologies account for
    35–70% of AKI cases

    • Post Renal
    Postrenal etiologies generally
    account for <5%

    1. http://www.medicalassessmentonline.net/terms.php?R=3
    2. Basille DP, et.al. Pathophysiology of Acute Kidney Injury. Compr Physiol. 2012
    April ; 2(2): 1303–1353. doi:10.1002/cphy.c110041.
    Pathophysiology
    Basile, David P et al. “Pathophysiology of acute kidney
    injury” Comprehensive Physiology vol. 2,2 (2012): 1303-53.
    Presentation

    Symptoms Signs
     Malaise  Hypertension

     Anorexia, Nausea and  Fluid overload:


    Vomiting peripheral oedema,
    SOB/ bibasal
     Pruritis
    crackles/raised JVP
     Dehydration
     Dehydration: postural
     Confusion, convulsions hypotension, poor urine
    output (palpable
    bladder)
    Workup
    1. Complete blood count (CBC)
    2. Serum biochemistries
     Myoglobin or free hemoglobin - Eg, pigment nephropathy
     Increased serum uric acid level - Eg, tumor lysis syndrome
     Serum lactate dehydrogenase (LDH) - Eg, renal infarction
    3. Urine analysis with microscopy
    4. Urine electrolytes
    5. Kidney Function Studies (BUN and creatinine)
    6. Ultrasonography
    7. Nuclear Scanning (Radionuclide imaging with technetium-
    99m-mercaptoacetyltriglycine (99m Tc-MAG3),99m Tc-
    diethylenetriamine penta-acetic acid (99m Tc-DTPA), or
    iodine-131 (131I)-hippurate)
    Workup

    8. Aortorenal Angiography
    9. Renal Biopsy
    10. Furosemide Stress Testing
    In early AKI, urine output after a furosemide stress test
    (FST) can predict the development of stage 3 AKI
    Treatment and Management

    • Conservative management

    • Relieving urological obstruction

    • Referral
    Conservative
    Management
    1. Correction of fluid overload with furosemide
    2. Correction of severe acidosis with bicarbonate
    administration, which can be important as a bridge
    to dialysis
    3. Correction of hyperkalemia
    4. Correction of hematologic abnormalities (eg,
    anemia, uremic platelet dysfunction) with measures
    such as transfusions and administration of
    desmopressin or estrogens
    5. All nephrotoxic agents (eg, radiocontrast agents,
    antibiotics with nephrotoxic potential, heavy metal
    preparations, cancer chemotherapeutic agents,
    nonsteroidal anti-inflammatory drugs [NSAIDs])
    should be avoided
    Relieving urological obstruction
     Refer all patients with upper tract urological obstruction to
    a urologist.

     Immediate referral if one or more of following present:

     Pyonephrosis

     Obstructed single kidney

     Bilateral upper urinary tract obstruction

     Complications of AKI secondary to urological


    obstruction
     When nephrostomy or stenting required – undertake as
    soon as possible and within 12 hours of diagnosis
    Referral
    Nephrology:
    Discuss AKI management with a nephrologist/paediatric nephrologist as
    soon as possible (and within 24 hours) if one of the following is present:
    Potential diagnosis requiring AKI with no clear Inadequate treatment
    specialist treatment (for example, cause response
    vasculitis or glomerulonephritis)
    Complications associated with AKI Stage 3 AKI eGFR is less than < 30
    ml/min/1.73 m2 after
    AKI episode
    Patients with renal transplant and CKD stage 4 or 5
    AKI
    Renal replacement therapy:
    Refer adults, children and young people immediately for RRT if any of the
    following are not responding to medical management:
    Hyperkalaemia Metabolic Symptoms or complications Fluid overload
    acidosis of uraemia such as +/- pulmonary
    pericarditis or oedema
    encephalopathy
    Thank
    You

    You might also like