Objective Acute kidney injury
Know about definition of Acute kidney injury
Function of kidney
Sign and symptoms of AKI
Know about Risk factor of AKI
Understand about complication of AKI
Contents:
Introduction Of Acute kidney injury
Physiology Of Acute kidney injury
Pathophysiology Of Acute kidney injury
Clinical feature Of Acute kidney injury
Risk Factor Of Acute kidney injury
Diagnosis Of Acute kidney injury
Differential diagnosis Of Acute kidney injury
Complication Of Acute kidney injury
Management Of Acute kidney injury
2. Objective
Know about definition of Acute kidney injury
Function of kidney
Sign and symptoms of AKI
Know about Risk factor of AKI
Understand about complication of AKI
4. I. Introduction
1. Definition
Acute kidney injury (AKI), Previously known as acute renal failure
(ARF), is an acute decline in renal function, leading to a rise in serum
creatinine and/or a fall in urine output.
5. 2. Epidemiology
In US, the total number of hospitalization for AKI increased from 953,926 in
2000 to 3,959,560 in 2014.
In UK, incidence range from 172 per million population per year up to 630 per
million population per year.
Overall, in cidence of AKI among hospitalized patient range from 13% to 22%.
7. II. Physiology
1. Excretory function
a. Metabolic
b. Drug
c. Toxins
2. Homeostatic functions
a. Maintained of water balance
b. Maintained of electrolyte balance
c. Maintained of acid-base balance
11. IV. Clinical feature
The mitral symptom
Fatigue
Malaise
Loss of ability to excrete water, salt and waste via kidney.
12. Clinical Manifestations
Pre renal: Decreased tissue turgor, dryness of mucous membrane,
weight loss, hypotension, oliguria or anuria, tachycardia.
Post renal: Obstruction to urine flow, nephrolithiasis, obstructive
symptoms of BPH.
Intra renal: Edema, presentation based on cause.
Changes in urine vol. And serum conc. Of BUN, creatinine, potassium
and so forth..
13. V. Risk Factors
Advanced age
Diabetes mellitus
Sodium-retaining states(Congestive heart failure, Cirrhosis,
Nephrotic syndrome).
Sepsis
Drug overdose.
14. 1. History & Physical Examination
History:
Age
Reduced urine production
Vomiting
Diarrhea
Hemorrhage
Diabetes mellitus
Drug abuse
Duration of symptoms ……
Physical Examination
Weight loss
Hypotension
Hypertension
Tachycardia
Poor skin turgor
Bladder distension
Prostate enlargement …….
VI. Diagnosis
15. VI. Diagnosis
2. Investigations
Blood test: blood test help find level of:
Creatinine :
• For male normal range (0.7 - 1.3) mg/dl
• For female normal range (0.6 - 1.1) mg/dl
BUN(Blood urea nitrogen) : normal range (7 -20 ) mg/dl
Phosphorus: normal range (2.5 - 4.5) mg/dl
Potassium: normal range (3.5 - 5.2) mEq/l (mille Equivalents per liter)
Calcium: normal range (8.5 – 10.5) mg/dl
17. VII.Differential diagnosis
AKI CKD
Cause
Ischemia
Nephrotoxins
Sepsis
Radiocontrast
Hypertension
Glomerulonephritis
Diabetes
Urinary obstruction
Hereditary
Duration of symptoms <90 days >90 days
Laboratory test
Increase serum creatinine
occurs rapidly over several
days.
Increase serum creatinine
over month to year.
Other diagnosis test
Proteinuria is rare or in low
amounts (< 500mg/24h).
Proteinuria is common and
high amounts (1g/24h).
19. IX. Management
Correct hypovolaemia and optimize systemic haemodynamic status with inotropic
drugs if necessary.
Administer glucose and insulin to correct hyperkalaemia if K+ > 6.5 mmol/L
Consider administering sodium bicarbonate (100mmol) to correct acidosis if PH<7
Discontinue potentially nephrotoxic drugs and reduce doses of therapeutic drugs
according to level of renal function
20. Match fluid intake to urine output plus an additional 500mL to cover
insensible losses once patient is euvolaemic.
Measure body weight on a regular basic as a guide to fluid requirements
Ensure adequate nutritional support.
Screen for intercurrent infections and treat promptly if present
IX. Management
21. Reference
Mayoclinic : June 23, 2018
https://www.mayoclinic.org/diseases-conditions/kidney-failure/symptoms-causes/syc-
20369048
(Step-Up Series) Steven S. Agabegi, Elizabeth D. Agabegi - Step-Up to Medicine-LWW
(2015)
Researchgate
https://www.researchgate.net/figure/Features-that-allow-the-differential-diagnosis-of-AKI-
and-CKD_tbl2_225055682
Sruart Ira Fox : Human Physiology
Dee Unglaub Silverthorn : Human Physiology, An Integrated Approach, Seventh
Edition.
Bmj-Best Practice, January 2019
https://bestpractice.bmj.com/topics/en-
gb/83?q=Acute%20kidney%20injury&c=suggested