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Acute Kidney Injury (Unified Renal failure Algorithm (Pt presents with…
Acute Kidney Injury
Unified Renal failure Algorithm
Pt presents with elevated Cr
R/o Prerenal
(LABS)
BUN/Cr ratio > 20
U Na <10%
FeNa <1%
Fr. excr of Urea <5%
:check:IF THEY SATISFY PRERENAL CRITERIA
Volume down?
IV fluids
Volume Up?
Diuresis
:pencil2:Just because they are prerenal doesn't mean you give fluids
:green_cross:IF R/O Prerenal
THEN
r/o Postrenal
(IMAGING)
CT (stones)
US (hydronephrosis)
:check:Hydroureter or hydronephrosis
:checkered_flag:POSTRENAL
Tx: relieve obstruction
Foley if bladder obs
Nephrostomy or Sx at level of ureter
:green_cross:IF NOT Postrenal
R/O INTRARENAL (rare): Dx of exclusion
(PEE)
Hx and PEx to help
Then
UA
1 more item...
:pencil2:Can't use FeNa if they are on diuretic
Acute indications for
hemodialysis
AEIOU
Acidosis
Electrolytes
K
Ca
Intoxication (w/ dialyzable substances)
Overload
Uremia
Kidneys are 3 distinct entities
Prerenal
Postrenal
Hydroureter
Hydronephrosis
Urethra - level
Kinked Foley
BPH
Stones
Cancer
much more
Bladder -level
Neurogenic bladder
spinal cord injuries
drugs
Stones
Cancer
Ureter -level
Stones
Cancer
:pencil2:Obstruction
Intrarenal
Glomerulonephritis
Acute interstitial nephritis (AIN)
damage to tubules
See: Eosinophils
WBCs
WBC casts
: pyelonephritis
1 more item...
Acute Tubular necrosis: damage to tubules
Caused by things in the tubule that come into contact with the tubules and are toxic causing them to die
3 Phases of ATN
Prodrome
: rising Cr
oliguria
: low Urine
2 more items...
Muddy brown casts
Casts are not really useful for Dx, not sensitive nor specific
Think
Ischemia
: Prolonged prerenal
1 more item...
See RBC casts in urine
nephrotic syndrome
≥3.5 g/day protein
edema
incr. cholesterol
:warning:Distal system is affected more than proximal
Clog in the pipes
Poor Perfusion
bad pump: CHF :<3:
Hole: bleed or dehydration
nothing in the pipes remain
Third spacing
Pt is volume up: but volume leaks out of the arteries
Leaky pipes: third spacing loss of fluid
(-oses)
nephrosis
cirrhosis
gastrosis
1 more item...
Hole in the pipes (4Ds)
Diarrhea :poop:
Dehydration :potable_water:
Diuresis
Hemorrhage
Clog
Atherosclerosis
Old M patient :older_man::skin-tone-4:
Fibromuscular dysplasia
young F :woman::skin-tone-2: w/ 2º HTN & renal failure
:pencil2:Not enough flow to kidney for whatever reason