Acute Kidney Injury
Acute kidney injury is the new consensus term that replaces the term acute renal failure. This term was adopted because the condition is understood to be a continuum of injury, rather than a discrete episode of organ failure defined by arbitrary values - Dr John Schollum
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Acute Kidney Injury: Pearls and Pitfalls
Acute kidney injury (AKI) is a sudden, potentially reversible, kidney dysfunction with partial or complete loss of glomerular filtration resulting in electrolyte and fluid abnormalities as well as retention of nitrogenous waste products. In contrast, Chronic Kidney Disease (CKD) describes loss of kidney function for at least three months. While a decrease in Glomerular Filtration Rate (GFR) is used to categorize CKD, an increase in serum creatinine or decrease in urine output is used to characterize AKI. The most recent definition of AKI is provided by the Kidney Disease: Improving Global Outcomes (KDIGO) group which reconciled the 2004 RIFLE criteria and the follow-up AKIN update.
Accordingly,…
Resources
Does contrast cause kidney injury? The evidence
We shouldn’t talk about contrasts as one large group. Although there doesn’t seem to be a different between iso-osmolar and low-osmolar groups, a few individual agents appear to be consistently worse. This doesn’t mean that all contrasts result in kidney injury, but based on this data, iohexol and ioxaglate should be avoided.
Does IV contrast cause renal failure?
The question remains whether the observational prospective cohort studies underlying the definition of CI-AKI are convincing enough to support contrast as an independent risk for renal failure.
Acute Kidney Injury – A Simple Emergency Approach to AKI
Our experts recommend Ringers Lactate (RL) as the fluid of choice as it has relatively neutral effect on acid-base status and may reduce the risk of further AKI compared to Normal Saline. Consider 1L bolus up front followed by 150mL/hr and aim for a urine output of ≥50mL/hr (≥200mL/hr in rhabdomyolysis).
CRACKCast E097 – Renal Failure
This chapter covers an approach to acute and chronic kidney injuries, including causes, complications and treatments.
Kidney Boy on Acute Kidney Injury: Myths & Musings
Get a grip on acute kidney injury (AKI) with Dr. Joel Topf (AKA @kidney_boy), Kashlak’s Chief of Nephrology! We’ve put together an AKI highlight reel – focusing on practical tips and tricks to help you identify, diagnose and manage AKI, plus how to recognize AIN and random myths and musings on vancomycin, NSAIDS, contrast nephropathy, and the risk of NSF from gadolinium.
Acute Kidney Injury (AKI)
An acute kidney injury (AKI) is caused by a rapid deterioration in kidney function. This is a common, yet serious occurrence in hospitalised patients, with AKI occurring in up to 20% of hospital admissions.
Acute Kidney Injury: Common Considerations and Complications
. A recently introduced definition of AKI specifies a rise in SCr above baseline of at least 0.3 mg/dL within 48 hours or 50% above baseline within 7 days, or the presence of oliguria (< 0.5 ml/kg/h) for 6 hours. AKI may be subdivided into three broad categories corresponding loosely to the anatomical site of the abnormality or injury.
IMIowa - Internal Medicine Chief Blog
Acute kidney injury occurs in approximately 5% to 7% of hospital admissions and up to 30% of ICU admissions. Kidney Disease Improving Global Outcomes acute kidney injury (AKI) consensus guidelines define AKI as an increase in serum creatinine ≥0.3 mg/dL (26.5 µmol/L) within 48 hours, ≥1.5 times baseline (known to have occurred within the previous 7 days), or urine volume <0.5 mL/kg/h for 6 hours.
RIFLE Criteria and AKIN Classification
The ADQI formulated the RIFLE criteria in 2004 to allow for AKI to be objectively and uniformly defined.
Risk of Acute Kidney Injury After Intravenous Contrast Media Administration
In the largest well-controlled study of acute kidney injury following contrast administration in the ED to date, intravenous contrast was not associated with an increased frequency of acute kidney injury.
Acute Kidney Injury: Pearls and Pitfalls
Acute kidney injury (AKI) is a sudden, potentially reversible, kidney dysfunction with partial or complete loss of glomerular filtration resulting in electrolyte and fluid abnormalities as well as retention of nitrogenous waste products
EMCrit
Most cases of AKI will resolve without specific intervention (e.g. with treatment of underlying sepsis). However, occasionally a specific issue is identified which requires specific therapy (e.g. Foley catheter obstruction, glomerulonephritis). Finding these patients is a bit like hunting for a needle in a haystack.
Emergency Medicine Saint John
According to KDIGO guidelines AKI is define as an 1) increase in serum creatinine by ≥0.3 mg/dL (≥26.5 µmol/L) within 48 hours, or 2) an increase in serum creatinine ≥ 1.5 fold from baseline within 7 days, or 3) urine output <0.5 mL/kg/hour for 6 hours.
FOAMcast
typically a creatinine 1.5-2x the patient’s baseline is classified as acute kidney injury. Urine output can be increased initially but determine whether a patient is making urine and how much, as urine output <0.5 mL/kg/h qualifies as AKI.
Life in the Fastlane
AKI is the entire spectrum of disease (mild -> severe), and can be defined as an abrupt (1 to 7 days) and sustained (more than 24 hours) decrease in kidney function.
Kidney.org
Acute kidney injury (AKI), also known as acute renal failure (ARF), is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days.
Mind the Bleep
May be classified as pre-renal, intrinsic renal or post-renal. Prerenal causes include anything which reduces glomerular perfusion, most commonly systemic hypotension or hypovolaemia but also includes reduced or disrupted renal blood flow. Intrinsic renal causes are insults that directly damage the kidneys, including specific renal diseases, infections and nephrotoxic medications. Post-renal causes are any cause of obstruction of the renal or urological tracts.
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