• AKI = abrupt loss of renal function as detected by measurement of serum Cr and GFR, results in the retention of urea and other nitrogenous waste products
  
  

  Posted 06/21/16 11:31:12 AM by Anna Krigel

• AKI work up:
  
  - should focus on pre-renal, intrinsic renal, and post-renal causes
  - to assess for pre-renal, assess volume status on exam; if not clinically obvious, bolus 1-2L IV fluid
  - to assess for obstruction, order a renal ultrasound immediately; can even do bedside sono of bladder
  - to assess intrinsic renal causes of AKI, order a UA
  
  

  Posted 06/21/16 11:32:57 AM by Anna Krigel

• In thinking about AKI, can divide the kidney into its compartments
  
  1) Glomerulus - nephrotic or nephritic syndrome, see protein and/or RBCs on UA
  2) Vessels - vasculitides, thrombosis
  3) Tubules - ATN (50% of all cases of AKI)
  4) Interstitium - AIN, see WBCs on UA and can see systemic signs of fever, skin rash
  
  

  Posted 06/21/16 11:36:56 AM by Anna Krigel

• ATN pearls and management
  
  - ischemic ATN = oliguric
  - toxic ATN = distal tubules affected, usually not oliguric, most often from aminoglycosides
  - management of ATN is supportive with fluids and RRT if needed
  
  

  Posted 06/21/16 11:39:55 AM by Anna Krigel

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