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AKI (Treatment PREVENTION (?Statins
NOT dopamine, (used previously for…
AKI
Treatment
PREVENTION
?Statins
NOT dopamine, (used previously for vasodilation, water+ Na excretion, diuresis)
Fendolpam (dopamine receptor agonist)
Diuretics
Furosemide: D- Na/K/ATPase pump activity in thick ascending loop of Henle > I+ tubular washout D- energy expenditure
Attempt: to oliguric to non-oliguric, manage Fluid, HyperK and HyperCa
No proven benefit, do not delay RRT
ANP
Increases GFR (dilates afferent, constricts efferent, D- tubuloglomerular feedback)
D- reasorption of Na
D- medullary vasoconstriction
Reverses Endothelin induced vasoconstriction
-
Causes
-
-
Common in ICU
Sepsis 35% , Nephrotoxins 30% , Major Surgery 25%, Hypovoleamia, CCF
IAP, CPB, Rhabdomyolysis, Trauma
Decreased GFR
Failed nitrogenous waste excretion
Failed fluid and electrolyte homeostatis
High association with M&MHigh blood flow (20% C.O.)but to filtering cortex
Metabolically active thick ascending loop of ####Henle (medulla) requires low blood flow for resorption
=susceptible to ischaemic injury
Bidirectional realtionship with CKD
Methods of measurement
-
Inulin
fructose polysaccahride
completely excretedm,not secreted or reabosrbed
Classification
2004 Risk, Injury, Failure, Loss, ESRD
2007 AKINKidney Disease: Improving GLobal Outcomes staging
Serum Creatinine
increase >26.5 mmol/l in 48hours
1) 50% in 1 week
2) Increases by 100% (doubles)
3) Increases by 200% (3x baseline)
Urine Ouput
1)<0.5ml/kg X >6hrs
2) < 0.5ml/kg/hr x >12 hrs
3) <0.3ml/kg/hr X >24hr or
anuria >12hrs
Mortality
Die FROM AKI, not just with it
? Immune related as well as Fluid and electrolytes..
ATN requiring RRT: 40-80%
Organ faliure: x2=53%, x3=80% x5=100%
Risks for Mortality
65
Male
Health state compromised
Sepsis
Higher grading
Oliguric RF
No renal organ failure
Ventilated
TCP
Risks for Incidence Link Title
65
Infection on admission
CVS failure
CCF
Cirrhosis
Lymphoma/leuakaemia
Respiratory failure
Try determine course of disease WRT CKD
Urinalysis for epithelila cells, casts and granular casts
Novel Biomarkers
earlier rise
Monitor courseCystatin-C, NGAL, KIM1
(Neutrophil gelatin assoiciated lipocalicin, Kidney Injury Molecule)