1. 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

2. 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