Lecture 8:

Topic Summary
BUN • Sensitivity vs specificity in Tests – what is it telling you?
• ARBs and ACEIs, renin inhibitor, even diuretic (for protein urea) good for CKD BUT NOT AKI
• Preserving kidney – does not have to work very hard
• ARBs also good for CKD (as ACEI), not so much AKI
Creatinine Normal SCr = 0.5 – 1 mg/dL
• ↑ SCr = declining renal function
SCr for specificity
• SCr elevation = kidney injury
• With too much diuretics è slightly ↑ SCr
• Marker for actual renal function
• Produced by breakdown product of creatine phosphate in muscle
• Filtered by the kidney and used to estimate kidney function/filtration
• Inversely proportional to function: the higher the creatinine, the lower the filtration
Urine Normal UO = 1 ml/kg/d
Patients with liver disease
- Pay more attention to UO than Cr
- Do not have any muscle mass
Oliguria
- < 500 mL urine output/24 h
- <0.5 ml/kg/h
- Significatny; reduced – don’nt pay attention to Creatinine
Anuria
- < 100 mL urine output/24 h
- Barely any urine
- eGFR = ~0
Blood urea nitrogen Normal = 5 – 20 mg/dL
(BUN): - Look at for pre-renal AKI because it ~ ↑ faster than Cr
BUN for sensitivity
- Good at scanning and surveillance
- Bad because effective with many factors (ex. Steroids, tetracyclines, seizure, heat, T, fever) that can impact value
- Use for patients getting diuretics
- Too much è huge↑è give less “be more gentle”
- Good marker for pre-renal
- Urea nitrogen formed from protein catabolism by the liver
- Filtered by the kidney and used as an additional measure of kidney function
 - High BUN generally reflects lower filtration
- Caveat: BUN can increase independent of kidney function
- Steroids, tetracycline antibiotics, or reabsorption of blood in GI tract
Uric acid Normal = 3.0 – 6.5 mg/dL
- ↑ can è uric acid crystals in urine
- Can be caused by methotrexate
-

AKI - BAD
- In critically ill patients with AKI:
- • Mortality between 40-60% in a 60-day-interval
- • Hospital stay prolonged
- Even if recover, may have complications or develop CKD later

People who are susceptible and should be generally monitored/followed:

- Health conditions
- Diabetic
- Demographics
- Older age
- Status
- Significant blood loss
- Dehydrated
- Medications
- NSAIDs
- High dose ACEIs
 - Aminoglycosides (ex. Gentamicin)
At increased risk
- You can have the most benefit from intervention
↑ Cr,↓UO, and complications – too late to reverse
Could have insult later:
- Abx, HTN, DM, high NSAID dose, etc.

All è complications and patient dies from complications of AKI

AKI Categories Pre-renal: event started externally from kidney and lead to KI
- Ex. Bleeding episode post-op, dehydrated, infection, GI issues (NVD)
Intrinsic renal
Post-renal
Pre-renal AKI • Volume depletion
• Ex. Bleeding, dehydration, hypovolemia, infection, vomiting, not eating, diarrhea, GI issues
• Decreased effective arterial blood volume HF, sepsis