Acute kidney injury Year 4 Internal Medicine Notes OmpathStudy

Acute kidney injury Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / I MED BEAUTIFUL NOTES / RENAL -- ● Objectives: ● Define​ ​Acute​ ​Kidney​ ​Injury ● Know​ ​the​ ​epidemiology​ ​of​ ​Acute​ ​Kidney​ ​Injury ● Know​ ​the​ ​etiology​ ​of​ ​Acute​ ​Kidney​ ​Injury ● Manage​ ​Acute​ ​Kidney​ ​Injury:\n○ Diagnose​ ​ ​Acute​ ​Kidney​ ​Injury\n○ Treat​ ​Acute​ ​Kidney​ ​Injury\n\n [​ ​Color​ ​index​ ​:​ ​ ​Important​ ​ ​ ​ ​Notes​ ​ ​ ​Extra​ ​] ● Resources: ● 435​ ​slide\n\n● Done​ ​by:​ ​Malak​ ​Alshareef​ ​&​ ​Mohammed​ ​Alfawaz ● Team​ ​sub-leader:​ ​ ​Shamma​ ​Alsaad ● Team​ ​leaders:​ ​Khawla​ ​AlAmmari​ ​&​ ​Fahad​ ​AlAbdullatif ● Revised​ ​by:​ ​Ahmad​ ​Alyahya \n\n Acute​ ​Kidney​ ​Injury​ ​Definitions Traditionally​ ​referred​ ​to​ ​as​ ​acute​ ​renal​ ​failure​ ​(ARF),​ ​it​ ​has​ ​many​ ​definitions. 1-​ ​Acute​ ​kidney​ ​injury​ ​definition:​ ​​ ​The​ ​old​ ​generic/descriptive​ ​definition​ ​is​ ​ARF\n- Deterioration​ ​of​ ​renal​​ ​function​ ​over​ ​a​ ​period​ ​of​ ​hours​ ​to​ ​days​,​ ​resulting​ ​in:\n➔ The​ ​failure​​ ​of​ ​the​ ​kidney​ ​to​ ​excrete​ ​nitrogenous​ ​waste​ ​products\n➔ And​ ​to​ ​maintain​​ ​fluid​ ​and​ ​electrolyte​ ​homeostasis​.\n- Olig​uria:​ ​ ​<400​ ​ml​ ​urine​ ​output​ ​in​ ​24​ ​hours.\n- An​uria:​ ​<100​ ​ml​ ​urine​ ​output​ ​in​ ​24​ ​hours.\n\n2-​ ​ARF(AKI)​ ​in​ ​one​ ​study​ ​was​ ​defined​ ​as:\n➔ a​ ​0.5​ ​mg/dL​ ​increase​ ​in​ ​serum​ ​creatinine​ ​if​ ​the​ ​baseline​ ​serum​ ​creatinine​ ​was​ ​≤1.9​ ​mg/dL.\n➔ Or​ ​an​ ​1.0​ ​mg/dL​ ​increase​ ​in​ ​serum​ ​creatinine​ ​if​ ​the​ ​baseline​ ​serum​ ​creatinine​ ​was​ ​2.0​ ​to​ ​4.9​ ​mg/dL.\n➔ Or​ ​a​ ​1.5​ ​mg/dL​ ​increase​ ​in​ ​serum​ ​creatinine​ ​if​ ​the​ ​baseline​ ​serum​ ​creatinine​ ​was​ ​≥5.0​ ​mg/dl.\n​ ​So​ ​you​ ​can​ ​see​ ​physician​ ​define​ ​a​ ​case​ ​as​ ​AKI,​ ​while​ ​someone​ ​else​ ​don’t​ ​,​ ​that’s​ ​why​ ​they​ ​set​ ​RIFLE​ ​criteria.\n\n3-​ ​RIFLE​ ​criteria:\nGFR/Creatinine​ ​criteria Urine​ ​Output​ ​criteria \nR​isk Increase​ ​in​ ​creatinine​ ​x1.5​ ​Or​ ​GFR​ ​decrease​ ​ 25% <​ ​0.5​ ​ml/kg/hr​ ​for​ ​6​ ​hrs \nI​njury Increase​ ​in​ ​creatinine​ ​x​ ​2​ ​Or​ ​GFR​ ​decrease​ ​ 50% <​ ​0.5​ ​ml/kg/hr​ ​for​ ​12​ ​hrs \nF​ailure Increase​ ​in​ ​creatinine​ ​x​ ​3​ ​Or​ ​GFR​ ​decrease​ ​ 75% ​ ​<​ ​0.3​ ​ml/kg/hr​ ​for​ ​24​ ​hrs\n​ ​or​ ​Anuria​ ​for​ ​12​ ​hrs \nL​oss Persistent​ ​ARF​ ​=​ ​Complete​ ​loss​ ​of​ ​renal​ ​function​ ​ ​ ​4​ ​weeks \nE​SRD End​ ​Stage​ ​Renal​ ​Disease​ ​ ​ ​3​ ​months \n​ ​ ​ ​ ​ ​ ​ ​Then,​ ​they​ ​noticed​ ​there​ ​is​ ​a​ ​difference​ ​ ​in​ ​defining​ ​GFR,​ ​so​ ​they​ ​set​ ​AKI​ ​stages\n\n4-​ ​AKI​ ​stages:\nStage Creatinine​ ​criteria Urine​ ​Output \n- 1.5-2​ ​times​ ​baseline <0.5​ ​ml/kg/h​ ​for​ ​ 6​ ​h\nAKI​ ​stage​ ​ ​I - OR​ ​0.3​ ​mg/dl​ ​increase​ ​from​ ​baseline​ ​(≥​ ​26.4\nµmol/L) \nAKI​ ​stage​ ​ ​II - 2-3​ ​times​ ​baseline <0.5​ ​ml/kg/h​ ​for​ ​ 12​ ​h \n- 3​ ​times​ ​baseline <0.3​ ​ml/kg/h​ ​for​ ​ 24​ ​h\nAKI​ ​stage​ ​ ​ ​III - OR​ ​0.5​ ​mg/dl​ ​(44​ ​µmol/L)​ ​increase OR\n​ ​ ​ ​ ​ ​ ​ ​if​ ​baseline​ ​ ​ ​4​ ​mg/dl(≥​ ​354​ ​µmol/L) Anuria​ ​for​ ​ 12​ ​h\n- OR​ ​Any​ ​renal​ ​replacement​ ​therapy​ ​given \nThese​ ​values​ ​and​ ​stages​ ​are​ ​based​ ​on​ ​the​ ​difference​ ​of​ ​mortality​ ​rate​ ​which​ ​is​ ​shown​ ​below.\nFor​ ​example:​ ​patient​ ​presented​ ​with​ ​Cr​ ​100​ ​µmol/L,​ ​and​ ​his​ ​baseline​ ​was​ ​70​ ​µmol/L,​ ​what​ ​does​ ​he​ ​have?​ ​AKI​ ​stage​ ​I​ ​(note​ ​the​ ​difference\nwas​ ​more​ ​than​ ​26.4​ ​µmol/L) \n\n ● Acute​ ​kidney​ ​injury,​ ​mortality,​ ​length​ ​of​ ​stay,​ ​and​ ​costs​ ​in​ ​hospitalized​ ​patients:\n19,982​ ​pts​ ​admitted​ ​to​ ​academic​ ​medical​ ​centre​ ​in​ ​SF​ ​9,205​ ​pts​ ​with​ ​ 1​ ​creatinine​ ​results.\nRise​ ​in​ ​creatinine Multivariable​ ​OR\n(hospital​ ​mortality) \n≥​ ​0.3​ ​mg/dl​ ​(26.4​ ​µmol/L) 4.1 \n≥​ ​0.5​ ​mg/dl​ ​(45​ ​µmol/L) 6.5 \n≥​ ​1.0​ ​mg/dl​ ​(90​ ​µmol/L) 9.7 \n≥​ ​2.0​ ​mg/dl​ ​(180​ ​µmol/L) 16.4\nYou​ ​can​ ​notice​ ​that​ ​mortality​ ​rate​ ​increases​ ​when​ ​Creatinine​ ​is​ ​higher.\n\n 5-​ ​KDIGO​ ​Definition​ ​for​ ​AKI:​ ​the​ ​latest​ ​definition​ ​for​ ​AKI\nAn​ ​abrupt​ ​within​ ​48​ ​hours​:\n➔ Absolute​ ​increase​ ​in​ ​creatinine​ ​by​ ​0.3​ ​mg/dl​ ​(26.4​ ​µmol/l)​.\n➔ Or​ ​percentage​ ​increase​ ​of​ ​ 50%​ ​from​ ​baseline.\n➔ Or​ ​urine​ ​output​ ​<0.5​ ​ml/hour​ ​for​ ​6​ ​hours.\n\n Epidemiology​ ​and​ ​impact​ ​of​ ​Acute​ ​Kidney​ ​Injury It​ ​occurs​ ​in:\n● 5%​ ​of​ ​all​ ​hospitalized​ ​patients.\n● 35%​ ​of​ ​those​ ​in​ ​ICU.​ ​Due​ ​to​ ​hypotension,​ ​sepsis,​ ​septic​ ​shock​ ​as\nwell​ ​as​ ​nephrotoxic​ ​medications​ ​they​ ​will​ ​develop​ ​AKI. Mortality​ ​is​ ​high​ ​in:\n● Up​ ​to​ ​75–90%​ ​in​ ​patients​ ​with​ ​sepsis.\n● 35–45%​ ​in​ ​those​ ​without​ ​sepsis.\nHospitalized​ ​patient,​ ​not​ ​community.​ ​It’s​ ​much​ ​lower​ ​in​ ​community\n\nAKI​ ​impact: Correlation​ ​between​ ​AKI​ ​classification​ ​and​ ​outcome: 22,303​ ​adult​ ​patients​ ​