Prerenal Acute Kidney Injury Pathophysiology and Presentation
- Decreased Renal Perfusion
- Decreased GFR
- Increased Sodium and Water Reabsorption
- Edema
- Dyspnea
- Hypotension with Tachycardia
- Altered Mental Status
- Oliguria
- NSAIDs
- Renal Artery Stenosis
- ACE Inhibitors
Acute Tubular Necrosis
- Ischemic Injury
- Nephrotoxic Injury
- Granular Muddy Brown Casts
- Intrinsic Renal Failure
- Oliguric Phase
- Metabolic Acidosis
- Hyperkalemia
- Increase in BUN and Creatinine
- Polyuria Phase
- Decrease in BUN and Creatinine
- Hypokalemia
- Supportive Care
Chronic Kidney Disease Early Symptoms Assessment
- GFR < 60mL/min
- Accumulation of Waste Products
- General Malaise
- Hypertension
- Proteinuria
- Hyperkalemia
- Mineral and Bone Disorders
- Neuropathy
Chronic Kidney Disease Late Symptoms Assessment
- Metabolic Acidosis
- Severe Uremia
- Arrhythmias
- Edema
- CNS Depression
- Anemia
- Oliguria
- Pruritus
- End Stage Renal Disease (ESRD)
- GFR < 15mL/min
Chronic Kidney Disease Interventions
- Daily Weights
- Strict I/O
- Renal Diet
- Strict Medication Regimen
- Erythropoietin
- Manage Hyperkalemia
- Manage CKD-MBD
- Dialysis
- Kidney Transplant
Renal Osteodystrophy
- Chronic Kidney Disease
- Secondary Hyperparathyroidism
- Hyperphosphatemia
- Hypocalcemia
- Decreased Calcitriol
- Osteitis Fibrosa Cystica
- Osteoporosis
- Osteomalacia
- Treating Underlying Disorder
Prerenal Acute Kidney Injury Diagnosis and Management
- BUN:Creatinine Ratio > 20:1
- Fractional Excretion of Sodium (FENa) < 1%
- Urine Osmolality > 500 mOsm/kg
- Hyaline Casts
- Fluid Replacement
- Monitor Renal Function
- Diuretics
Postrenal Acute Kidney Injury Pathophysiology and Presentation
- Bilateral Outflow Obstruction
- Decreased GFR
- Benign Prostatic Hyperplasia (BPH)
- Nephrolithiasis
- Neoplasm
- Neurogenic Bladder
- Bladder Distension
- Lower Abdominal Pain
- Edema
- Oliguria
Post Renal Acute Kidney Injury (AKI) Diagnosis and Management
- Physical Examination
- BUN:Creatinine ratio of 20:1 in the Initial Stages
- BUN:Creatinine ratio of 10:1 in the late stages
- Urine Osmolality <350 mOsm/kg
- Variable Fractional Excretion of Sodium (FENa)
- Ultrasound
- CT Scan
- Treat Underlying Cause
Intrinsic Renal Failure
- Acute Tubular Necrosis
- Acute Interstitial Nephritis
- Vasculitis
- Malignant Hypertension
- Acute Glomerulonephritis
- TTP-HUS
- Fractional Excretion of Sodium (FENa) > 2%
- Urine Osmolality < 350 mOsm/kg
- Urine Na+ >40 mEg/L
- Serum BUN/Cr < 15
- Treat Underlying Disorder