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AKI Case Preentation
AKI Case Preentation
Case presentation
Aug.2019
Case
A 70 yrs old female patient , w/ Hx of diabetes ( last HbA1c 8 ,
On insulin ) and HTN ( on captopril and diuretic ) , REF-HF
( EF <40%)
Eye No jaundice ( liver dx) , no band keratopathy ( Multiple myeloma ) , no keratitis , uveitis
vasculitis )
By definition : A K I is
• Serum Cr increase • Decreased urine
by > 0.3 mg/dl output <0.5 ml/kg
within 48 hrs over 6 hrs
Up to date
• Signs of volume depletion
History • Hypotensive , Tachy , Pallor , dizziness
Up to date
• Cbc
• KFT
History • LFT
Physical examination
• EGFR
Labs Urine analysis:
And urine analysis 1. urine dipstick( PH, albumin, glucose, Hbg, leukocyte
Imaging esterase) ,
2. Microscopic examination of the urine sediment
3. Urine volume:
oliguria <500 ml/day
Anuria <50 ml/day
4. Hematuria glomerular disease or vasculitis
5. Pyuria AIN
Up to date
Not indicated
History
Physical examination
Unless you want to Asses urinary
Labs tract obstruction renal ultrasound
Imaging • Urolithiasis Ct without contrast
( Hx of flank pain )
!! Avoid MRI
Up to date
Management
Up to date
Management
• Admission
• ABC / Stable /Check vitals
• Triage / Referral
• Assess fluid status
• Fluid resuscitation
• Treat underlying etiology
Up to date
Copyrights apply
• Patients with stage 2 or 3 AKI as per the KDIGO
ER referral criteria
Up to date
Renal
Urgent • Hypervolemia w/ pulmonary edema
• Toxin exposure
Up to date
Hyperkalemic Pulmonary edema
emergency We use 80 to 200 mg of intravenous (IV)
furosemide and monitor for an increase in
urine output
( We consider a urine output of greater than
200 mL within two hours of the furosemide
dose as adequate )
Up to date
Management
• Identify etiology of AKI
• Treat reversible cause ( Hypotension , Urinary Tract obstruction )
• X insult
• Medication : NSAIDS , ACE , ARBs , nephrotoxins (eg, aminoglycoside
antibiotics, amphotericin, tenofovir, nephrotoxic chemotherapy)
• Dosing adjustment based on GFR
• Hypotension ( identify and correct )
• Volume assessment – Primary aim of therapy
Up to date
Volume assessment
Hypovolemia Hypervolemia
oliguria ,hypotension , suggestive Hx Critically ill under obligate fluid intake (ATN ) ,
HF (cardio-renal ) , aggressive IV fluid
Up to date
Manage complications
Hyperkalemia Hyperphosphatemia
Restrict dietary phosphorous to <2 g
per day
. Phosphate binders in pts :-
. o phosphate concentration >5.5 mg/dL
o enteral feeding (eating or receiving tube
feeds)
Acid base disorders o likely prolonged course of AKI
o severe hypocalcemia
o continued release of intracellular
phosphate such as rhabdomyolysis and
tumor lysis syndrome
Up to date
F/U
• Serum creatinine, electrolytes, total serum calcium, phosphate, and
albumin should be measured daily in stable patients
• Monitor daily weights, fluid intake, and urine output in order to assess
daily fluid balance
Up to date
American Family
physician