ATN/ACUTE KIDNEY INJURY
AKI-sudden dec. in renal function manifested by accumulation of waste metabolites
-kidney cannot form and excrete urine
* recovery depends on health status
CAUSES: hypoTN, hypoVOLemia, nephrotoxic agent exposure
CATEGORIES OF ARF
-pre-renal: involves external pbl from kidney
reduce bld flow leading to dec GFR
low urine NA
CAUSES: HYPOVOLEMIA, DEC. co, DEC SVR
-intrarenal: direct dmg in kidney
-Acute Tubular necrosis: dmg to kidney
caused from surg with hypoTN/hypoVOL....ischemia and sepsis #1
NSG: look at VS during surg
-Post Renal: mechanical obstruction to outflow
if fixed w/in 45hr then recovery is likely
RIFLE CLASSIFICATION
Risk: Cr inc by 1.5 or GFR dec 25%
UO<0.5ml/KG x 6hr
Injury: Cr inc by 2 or GFR dec 50%
UO<0.5ml/KG/12 hr
Failure: UO<0.3ML/KG/24H=oliguria; GFR dec 75%
anuria x 12hr
End Stage kidney disease: complete loss >3mths
, Phases of AKI
-Onset- what caused it?
-intervene early
-notice UO dec. with with BUN?CR increasing
-Oliguric-1-7 days
- last 10-14 days but can be months
-rapid inc. in BUN/CR so hyperkalemia is #1 hazard
-less than 400ml/24hr; anuric is less than 100ml/24hr
-met. acidosis
-Diuretic...osmotic diuresis
-will have 1-3L/d of UO
-high output but not well concentrated
-can last weeks
-hypovolemia/hypoTN/
-know getting better when output dec 1000L/d than BUN?CR start to fall
-Recovery
-some GFR won't return to normal
TREATMENT
depends on underlying cause
GIVE FLUIDS TO MAKE SURE PIPES ARE FULL AND FILLING KIDNEYS
dIURETICS-LASIX, BUMEX,
LOW DOSE DOPAMINE-renal arterial dilation 1-3MKM
AKI-sudden dec. in renal function manifested by accumulation of waste metabolites
-kidney cannot form and excrete urine
* recovery depends on health status
CAUSES: hypoTN, hypoVOLemia, nephrotoxic agent exposure
CATEGORIES OF ARF
-pre-renal: involves external pbl from kidney
reduce bld flow leading to dec GFR
low urine NA
CAUSES: HYPOVOLEMIA, DEC. co, DEC SVR
-intrarenal: direct dmg in kidney
-Acute Tubular necrosis: dmg to kidney
caused from surg with hypoTN/hypoVOL....ischemia and sepsis #1
NSG: look at VS during surg
-Post Renal: mechanical obstruction to outflow
if fixed w/in 45hr then recovery is likely
RIFLE CLASSIFICATION
Risk: Cr inc by 1.5 or GFR dec 25%
UO<0.5ml/KG x 6hr
Injury: Cr inc by 2 or GFR dec 50%
UO<0.5ml/KG/12 hr
Failure: UO<0.3ML/KG/24H=oliguria; GFR dec 75%
anuria x 12hr
End Stage kidney disease: complete loss >3mths
, Phases of AKI
-Onset- what caused it?
-intervene early
-notice UO dec. with with BUN?CR increasing
-Oliguric-1-7 days
- last 10-14 days but can be months
-rapid inc. in BUN/CR so hyperkalemia is #1 hazard
-less than 400ml/24hr; anuric is less than 100ml/24hr
-met. acidosis
-Diuretic...osmotic diuresis
-will have 1-3L/d of UO
-high output but not well concentrated
-can last weeks
-hypovolemia/hypoTN/
-know getting better when output dec 1000L/d than BUN?CR start to fall
-Recovery
-some GFR won't return to normal
TREATMENT
depends on underlying cause
GIVE FLUIDS TO MAKE SURE PIPES ARE FULL AND FILLING KIDNEYS
dIURETICS-LASIX, BUMEX,
LOW DOSE DOPAMINE-renal arterial dilation 1-3MKM
