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Regulatory: Acute Kidney Injury - Coggle Diagram
Regulatory: Acute Kidney Injury
Complications
Death
Seizure
Coma
Dysrhythmias
Hyperkalemia and overall F/E imbalances
Uremia
Metabolic acidosis
Fluid overload
Hypertensive crisis
Sepsis
Pulmonary edema
Signs and Symptoms
Tachycardia
Azotemia
Hypertension/Hypotension
Bibasilar crackles
Altered mental status
Oliguria/anuria
Seizures
Dysuria
Distended bladder
Flank pain
Severe hematuria
Ischemia
Dysrhythmias
Labs
BUN
CCT
Urinalysis comprehensive metabolic panel
US
Doppler
CT
Renal angiography
Biopsy
Collaborative Treatment
Fluid administration carefully
Hemodialysis
CRRT
Kidney transplant - not often
Low sodium/protein diet mix
Correct electrolyte imbalances
Risk factors
Major trauma/surgery
Infection
Severe heart failure
no pressure, no pee
Lower mechanical obstructions
Drug/OTC use - St. John's Wort, aminoglycosides, ACE inhibitors
Age - elderly
CAD
Diabetes
Liver disease
Obesity
Prolonged hypotension
Severe burns
Muscle injury
Rhabdomyolysis
Pathophysiology
Prerenal - circulatory complications or compensatory mechanisms leads to a sudden decrease in hypoperfusion of the kidneys. This hypoperfusion leads to a decrease in filtration pressure along with a decrease in urinary output (1st sign) and GFR. Decreased filtration allows for renal tubules to reserve energy - hypovolemia, altered vascular resistance, and decreased CO.
Intrarenal - Structural damage to the kidneys due to hypoperfusion leading to ischemic damage/toxins damaging the internal structures/inflammation - anti-inflammatory mediators.
Postrenal - tubular pressure increase due to a mechanical obstruction of the kidney, which decreases filtration pressure and urine outflow. BPH, renal pelvis obstruction, bladder tumor, injury, kidney stones, fecal impaction.