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Anuria ec Acute Kidney Injury - Coggle Diagram
Anuria ec Acute Kidney Injury
Clinical Presentation
present with listlessness, confusion, fatigue, anorexia, nausea, vomiting, weight gain, or edema
Patients can also present with oliguria (urine output less than 400 mL per day), anuria (urine output less than 100 mL per day), or normal volumes of urine (nonoliguric acute kidney injury)
development of uremic encephalopathy (manifested by a decline in mental status, asterixis, or other neurologic symptoms), anemia, or bleeding caused by uremic platelet dysfunction
Prognosis
more likely to develop chronic kidney disease in the future
Definition of Acute Kidney Injury
an abrupt (within hours) decrease in kidney function, which encompasses both injury (structural damage) and impairment (loss of function).
AKI is staged for severity according to the following criteria
stage 2
≥2.0–2.9 times baseline in serum creatinine
Urine volume <0.5 mL/kg/h for ≥12 hours
stage 3
decrease in eGFR to <35 mL/min per 1.73 m2
Anuria for ≥12 hours
stage 1
1.5–1.9 times baseline increase in serum creatinine
Urine volume <0.5 mL/kg/h for 6–12 hours
Management
If fluid resuscitation is required because of intravascular volume depletion, isotonic solutions (e.g., normal saline) are preferred over hyperoncotic solutions (e.g., dextrans, hydroxyethyl starch, albumin)
Attention to electrolyte imbalances (e.g., hyperkalemia, hyperphosphatemia, hypermagnesemia, hyponatremia, hypernatremia, metabolic acidosis) is important.
The key to management is assuring adequate renal perfusion by achieving and maintaining hemodynamic stability and avoiding hypovolemia.
Supportive therapies (e.g., antibiotics, maintenance of adequate nutrition, mechanical ventilation, glycemic control, anemia management) should be pursued based on standard management practices.
Aetiology of Acute Kidney Injury
Instrinsic
Tubular
Renal ischaemia
Glomerular
Acute post-infectious glomerulonephritis, Lupus nephritis
Vascular
vasculitis, malignant hypertension
Postrenal
Extrarenal obstruction
Prostate hypertrophy
Improperly placed catheter
Bladder, prostate or cervical cancer
Retroperitoneal fibrosi
Intrarenal obstruction
Nephrolithiasis
Blood clots
Papillary necrosis
Prerenal
Impaired cardiac function
Increased vascular resistance
Hypovolaemia
Diagnose Banding Anuria (tidak bisa BAK)
Pembesaran Prostat
Batu Ginjal
Dehidrasi Berat
Diabetes
kerusakan pada pembuluh darah di ginjal. Kondisi ini disebut juga dengan ketoasidosis diabetikum.
menyebabkan gagal ginjal akut dan produksi urine menburuk
Tumor
Diagnosis
Pemeriksaan Fisik
Physical examination should assess intravascular volume status and any skin rashes indicative of systemic illness.
Pemeriksaan Penunjang
serum creatinine level
A high serum creatinine level in a patient with a previously normal documented level suggests an acute process, whereas a rise over weeks to months represents a subacute or chronic process.
urinalysis
guide the differential diagnosis and direct further workup
complete blood count
The presence of acute hemolytic anemia with the peripheral smear showing schistocytes in the setting of acute kidney injury should raise the possibility of hemolytic uremic syndrome
Renal ultrasonography
particularly in older men, to rule out obstruction (i.e., a postrenal cause)
Renal biopsy
for patients in whom prerenal and postrenal causes of acute kidney injury have been excluded and the cause of intrinsic renal injury is unclear.
Anamnesis
The history should identify use of nephrotoxic medications or systemic illnesses that might cause poor renal perfusion or directly impair renal function.
Gathan Gufraan