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Acute Kidney Injury. 2016m Unismuh
Acute Kidney Injury. 2016m Unismuh
(AKI)
Haerani Rasyid
2016
Learning Objectives
• Definitions and classification of AKI
• Epidemiology and clinical outcome
• Etiology and diagnosis
• Management of AKI
Definition
• Acute kidney injury (AKI)—or acute renal failure
(ARF), as it was previously termed—is defined
as an abrupt or rapid decline in renal filtration
function. This condition is usually marked by :
1. a rise in serum creatinine concentration
2. creatinine levels may be normal, and the
only sign of a kidney injury may be
decreased urine production.
Definition (cont...)
According to KDIGO (Kidney Disease Improving
Global Outcome), AKI definition :
• Serum Cr↑by 1.5x baseline for 7 days OR
• Cr↑by ≥ 0.3 mg/dl for 48 hours OR
• Urine output < 0.5 ml/kg/hour for 6 hours
KDIGO Classification of AKI ( 2012 )
Stage Serum creatinine Urine output
Stage Cr Criteria UOP Criteria
1 1.5-1.9× baseline <0.5 ml/kg/hr for 6-12 hrs
1OR Cr↑by 1.5-2x baseline or < 0.5 ml/kg/hr for
Cr↑by 0.3 mg/dl 6hr
>0.3 mg/dL
2 Cr↑by 2-3x <0.5
< 0.5 ml/kg/hr
ml/kg/hr for> 12 hrs
2 2-2.9× baseline 12hr
3 Cr↑by more than 3x or < 0.3 ml/kg/hr for
3 3 timesCr↑by 0.5 if baseline >4mg/dl
baseline 24hr ml/kg/hr > 24 hrs
<0.3
OR Or anuria for 12h
OR
increase in Cr to ≥4.0 mg/dL Anuria > 12 hrs
OR
Initiation of RRT
RIFLE criteria for Acute Renal Dysfunction
GFR criteria Urine output criteria
Abrupt (1-7 days)
Decreased UO relative to
decrease (> 25%) in GFR
Risk Or Scr x 1.5
the fluid input
High Sensitivity
UO < 0.5/ml/kg/h x 6hr
Sustained (> 24 hrs)
Adjusted creat or
uria
UO < 0.5/ml/kg/h
Injury GFR decrease> 50% x 12 hr ??
Olig
or Scr x 2
• Intratubular Obstruction
– myoglobin, hemoglobin, myeloma light chains,
uric acid, tumor lysis, drugs (bactrim, indinavir,
acyclovir, foscarnet, oxalate in ethylene glycol toxicity)
Renal AKI – Acute Tubular Necrosis
• ATN - Acute Tubular Necrosis
– Usually occurs after an ischemic event or exposure to nephrotoxic
agents.
– Look for muddy brown casts and FeNa>2%
• Direct toxic Injury (20%)
• Sepsis (48%) – Exogenous
• Radiocontrast
• Ischemia (32%) • Aminoglycosides
• Vancomycin
– prolonged prerenal azotemia • Amphotericin B
– Hypotension • Cisplatin
– hypovolemic shock • Acyclovir
• Calcineurin inhibitors
– cardiopulmonary arrest • HIV meds (tenofovir)
– cardiopulmonary bypass .
– Endogenous (pigment nephropathy)
• Rhabdomyolysis
• Hemolysis
Renal AKI – Acute Tubular Necrosis
Index Prerenal Oliguric AKI
Azotemia (ATN)
BUN/PCr Ratio >20:1 10-15:1
Urine sodium <20 >40
(UNa), meq/L
Urine osmolality, >500 <400
mosmol/L H2O
– Oliguria/Anuria
– Hyperammonemia
– Hyperkalemia
– Severe acidemia
– Severe azotemia
– Pulmonary Edema
– Uremic complications
– Severe electrolyte abnormalities
– Drug overdose with a filterable toxin
– Anasarca
– Rhabdomyolysis
THANK YOU...