AKI – Acute Kidney Injury C.L.I.P.S. Definition/Classification: RIFLE Etiology: Pre-Renal: decreased blood flow = volume depletion (hypotension, hemorrhage, diarrhea), decreased cardiac output, CHF, HTN, liver failure, renal vascular disease (ACEi, ARB, NSAIDs) Intrinsic: cytotoxic, ischemic, inflammatory Acute Glomerulonephritis autoimmune, nephrotic/nephritic synd. (anti-GBM, ANCA) Vascular (embolic, vasculitis, HUS) Tubulointerstitial AIN (infection, NSAIDs, abx) *ATN (ischemic, toxic) Nephrotoxins: contrast, AmphoB, aminoglycosides, hemolysis, rhabdo, myeloma Post-Renal: ureter, bladder, urethral outlet obstruction (BPH, metastatic cancers, stricture, thrombosis, renal calculi), anticholinergic BUN:cr >20 = prerenal <20 = intrinsic FENa fractional excretion of sodium UNa   x   SCr ------------ SNa   x   UCr <1 = prerenal >2 = postrenal (ATN)   GFR criteria Urine output criteria Risk Cr increase 1.5x or GFR dec >25% UO < 0.5 ml/kg/h x 6H Injury Cr increase 2x or GFR dec >50% UO < 0.5 ml/kg/h x 12H Failure Cr increase 3x or GFR dec >75% OR Serum cr > 4mg/dl UO < 0.3 ml/kg/h x 24H or anuria x 12 H Loss Persistent ARF = complete loss of kidney function >4 weeks ESKD End stage kidney disease (>3months) Updated 6/2018

AKI – Acute Kidney Injury C.L.I.P.S. Diagnostic Tools: UA (muddy brown casts, WBC), Urine culture, Renal U/S, CBC, peripheral smear (HUS, TTP), renal biopsy (infrarenal) Management: Determine the etiology/cause Remove active insults Minimize new injury (renal dosing of meds) Identify and correct acute complications Volume hemostasis Hyperkalemia, hypocalcemia, hyperphosphatemia, acidemia Bleeding due to platelet dysfunction Dialysis Indications: AEIOU Acid Base disorder: pH<7.1 Electrolyte: Hyperkalemia K>6.5 Intoxication: methanol, lithium, salicylates, ethylene glycol Overload of fluid, refractory to diuretics Uremic Symptoms: pericarditis, encephalopathy Other Complications: CV: fluid overload leading to HF, cardiac arrest, hyperkalemia GI: nausea, vomiting, signs of uremia Neuro: decline in mental status, lethargy, somnolence Hypovolemia= prerenal = give fluids! Blue toes = cholesterol emboli Drug rash = AIN Volume overload = heart failure Ascites & Jaundice = Hepatorenal Syndrome & Portal htn