Acute Kidney Injury

Patient with positive urine dipstick test for blood with no RBCs indicates?
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Patient with positive urine dipstick test for blood with no RBCs indicates?
Hemolysis
Rhadomyolysis
3 ways to measure renal function?
1. GFF [Holy Grail]
2. Creatinine Clearance
3. Cystatin C levels [- Less affected by age & sex - May estimate GFR better than serum creatinine - May be better predictor of adverse events in the elderly]
4. Modified MDRD
5. Cockcroft -Gault Formula [better for renally dosing meds]
- Increase in serum creat of ≥?? mg/dL within 48 hours OR
- Increase in serum creat of ≥?? times baseline within the prior 7 days
OR
- Urine volume <?? mL/kg per hour for more than 6 hours

Criteria for Acute Kidney Injury? Name?
KDIGO (Kidney Disease: Improving Global Outcomes)

0.3
1.5
0.5
The most common cause of acute kidney injury?
Acute tubular Necrosis [ATN]-45%

Prerenal Disease-21%
What drugs are most commonly associated with allergic interstitial nephritis?
-Omeprazole [PPIs]
-Allopurinol
-Sulfonamides
-Thiazides
-Furosemide
Patient with - RBCs/RBC casts in urine - Hypertension - Mild proteinuria. What type of Glomerular disease? Give Example.
Nephritic disease
- Postinfectious glomerulonephritis
- IgA nephropathy
- Rapidly progressive glomerulonephritis
- Membranoproliferative glomerulonephritis
- Henoch-Schönlein purpura
- Vasculitis
Patient with - Massive proteinuria [>3 g] - Edema/hypoalbuminemia - Hyperlipidemia - Hypercoagulable. What type of Glomerular disease? Give Example.
Nephrotic Syndrome
- Diabetic nephropathy
- Minimal change disease
- Focal segmental glomerulosclerosis
- Mesangial proliferative glomerulonephritis
- Membranous glomerulonephritis
- Primary amyloidosis
- Preeclampsia
Patient with T2DM [on metformin], Creatine 2.8, and SS Disease, needs a CT of abdomen with IV contrast to assess a tumor. What is patient at risk for? How do we decrease this possibility?
Contrast Induced Nephropathy

• Stop metformin x 48 hrs (particularly if eGFR <60)
• Isotonic solution IV hydration - Favored over hypotonic solutions & oral hydration
Patient with AKI or CKD. What medications should we avoid?
Nephrotoxic Meds
• NSAIDs
• Lithium
• Antibiotics - Aminoglycosides - Vancomycin - Amphotericin B - IV Acyclovir
• ACE/ARB
• Diuretics
• PPIs
• Methotrexate
Patient with T2DM on Metformin with eGFR <45 mL/min. Do we need to make any changes? Why?
Metformin -increased risk of Lactic Acidosis
• Consider reducing dose by 50% at that eGFR [GFR <45 mg/min]
-Do not start if eGFR <45 mL/min

• Do not use if eGFR <30 mL/min
Most LIKELY site/cause of AKI in Patient with FENa: - <1% =? - 1-2% =? - >2-3% = ?- <1% = prerenal - 1-2% = intrinsic renal/ diuretic use - >2-3% = ATNSystemic manifestation of acute kidney injury?Metabolic acidosis •Hyperphosphatemia •Hyperkalemia •Hypercalcemia/hypocalcemiaPatient with AKI Complication of Hyperkalemia. What is the initial treatment?Calcium gluconate 10% solution - 10 mL IV • Cardio protective/membrane stabilizer • Temporarily reverses the neuromuscular effects of hyperkalemia Insulin 10 Units IV and Glucose 25 gm/Inhaled beta agonist/Sodium Bicarb -Temporarily shifts K+ intracellularly Sodium Polystyrene Sulfonate [25-50g orally or 50 g with 150 mL tap water rectally] OR Patiromer -Eliminates K+Patient with AKI, when is dialysis indicated?-Hyperkalemia refractory to medical therapy or >6.5 -Volume overload unresponsive to diuretics - Metabolic acidosis with pH < 7. 1 -Uremic pericarditis/Encephalopathy-AMS/Neuropathy -Poisonings and intoxications [Ethylene glycol, lithium]Patient on ACE/ARB; Creatinine is increased. What is the necessary increase necessary for us to discontinue the ACE-I/AR and evaluate for other causes of renal dysfuction.If creatinine increases by more than 30%, agent (ACE-I or ARB) should be discontinued and other causes of renal dysfunction should be evaluated.