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ACUTE KIDNEY INJURY, CASE REVIEW
male, 30th
weakness
low urine…
ACUTE KIDNEY INJURY
DEFINITION
denotes a sudden and often reversible reduction in kidney function, as measured by increased creatinine or urine volume
- increase creatinine serum >0,3 mg/dl in 48 hours
- increase creatinine >1,5 in 7 days
- urine volume <0,5 ml/kgBB/hour in 6 hours
ETIOLOGI
- Pra-renal :arrow_right:reduced blood flow to the kidney. A disease that cause renal hypoperfusion without causing disruption on renal parencym
- Rena/intrinsik :arrow_right:disease that directly cause disruption on renal parencym
- Pasca-renal :arrow_right:disease that asociated with urinari tract obstruction
EPIDEMIOLOGY
incidence rate are variated, >5000 cases/million population/years (non-dialisis AKI). 295 cases/million population/years (AKI dialisis)
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SIGN & SYMPTOMS
- too little urin leaving the body(oligouri)
- swelling
- tiredness
- shortness of breath
- confusion
- nausea
- chest pain or pressure
- decreased body weight
- thirsty
PHYSICAL EXAMINATION
orthostatic hypotension and tachycardia, decreased JVP, decreased skin turgor, dry mucosa, stigmata of chronic liver disease and portal hypertension, signs of heart failure and sepsis.
SUPPORTING IVESTIGATION
- biokimia urin
- urin analisis
TREATMENT
- Pra renal :left_right_arrow: Rest. Diet. Medikamentosa(furosemid). Dialysis (hemodialysis, peritoneal dialysis)
- Renal :left_right_arrow:Rest. Diet. Medicamentosa if there infection (high dose furosemide). Dialisis if there uremia syndrom. Kidney Organ transplant surgery
- post renal :left_right_arrow:Rest. Diet. Surgery to fix the obstruction. Dialysis.
PROGNOSIS
The mortality rate is still high, especially for critical patients (53% ATN trial, 44.7% RENAL trial)
Can progress to CKD, ESRD, death
COMPLICATION
- disturbance of body fluid balance
- electrolyte balance disorders
- metabolic acidosis
- heart failure
- respiratory failure
ISLAMIC PERSPECTIVE
Indeed, Allah has sent down diseases along with their medicine, and He has made every disease have a cure, so seek treatment, but do not seek treatment with anything that is haram." (HR. Abu Dawud)
CASE REVIEW
- male, 30th
- weakness
- low urine output
- diarrhea 2 days ago, frequency >10x/days
- nausea and vomiting
- hypertension 5 years ago
- blood pressure 80/60 mmhg, pulse 110x/menit weak, respiratory rate 24x/minute, temperature 37,2
- creatinine 2,8 mg/dl, sodium 125, pottasium 5,2, chloride 93
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