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RISK
Increased creatinite x 1.5 or GFR decrease > 25%

UO < 0.5 ml kg-1h-1 x  6h
INJURY
Increased creatinite x 2 or GFR decrease > 50%

UO
FAILURE
Increased creatinite x 3 or GFR decrease > 75% or creatinine > 4 mg/100ml 

UO < 0.3 ml kg-1h-1 x 24 hr or anuria x 12 hours
LOSS
Persistent ARF = complete loss of renal function > 4 weeks
ESRD
End-stage renal disease
Normal urine output
> 1200 ml/day
Nonoliguric
> 400 ml/day
Oliguric
< 400ml/day
Anuric
< 50ml/day
Hgihter risk factors for hospitalized AKI
older age, infection, nephrotoxins, male gender, multi-organ dysfunction, need for mechanical ventilation
Most common death from AKI (4)
infection, bleeding, cardiopulmonary failure, withdrawal of life support
Prerenal
HF, contriction, decreased blood volume
postrenal
kidney stones from dehydration, uterine cancer, prostate cancer
NSAIDs ___________ the __________ arteriole
contrict, afferent
ACEI/ARBs _________ the ___________ arteriole
vasodilate, efferent
Hemorrhage, Skin losses, GI losses, Rena losses, fluid pooling
prerenal absolute decrease
congestive heart failure, sepsis, anaphylaxis, liver failure
relative decrease in blood volume
bilateral thromboembolism
Prerenal arterial occlusion
Prerenal Azotemia
-intravascualr volume depletion, decreased effective circulating volume, hypotension, shock, occlusion
-reduced blood flow to kidney
Functional AKI
impaired glomerular ultrafiltrate production or intraglomerular hydrostatic pressure
Intrinsic AKI
glomerular disorders, acute tubular necrosis, acute interstitial nephritis
-involves vasculitic disease or glomerular damage
Postrenal AKI
ureter obstruction

Cockroft-Gault
Crcl = [(140-age) x IBW] / [72 x SCr) ( x 0.85 if female)
Urine Na (mEq/L)
Prerenal: < 20
Intrinsic: > 40
Postrenal > 40
Fractional Excretion (FE)
Prerenal: 2%
Postrenal: >1%
Urine : plasma creatinite ratio
Prerenal: >40:1
Intrinsic:
Specific Gravity
Prerenal: >1.010
Intrinsic: < 1.010
Postrenal: variable
Urine osmolality (mOsm/kg)
Prerenal: > 500 up to 1200
Intrinsic: < 300
Postrenal: < 300
BUN: Scr ratio
Prerenal: >20:1
intrinsic:
Indomethacin
Prerenal high risk NSAID that treats gout
Naproxen, ibuprofen, Piroxicam, diclofenac
Prerenal Intermediate risk
Aspirin
Prerenal Low risk
Common causes of Acute Tubular Necrosis
Ischemia
(hypotension, surgery, spesis, burns)

Common causes of Acute Tubular Necrosis
Drugs
aminoglycosides, amphotericin B, radiocontrast media
Contrast Induced Nephropathy 
prevention
hydration, asorbic acid, acetylecysteine
Aminoglycoside-induced ATN
G > T > A
drug induced nephrolithiasis
acyclovir, indinavir, MTX, sulfonamides, triamterene
Postrenal AKI treatment
hydration
thiazides, allopurinol  alkalinization of urine with K citrate and K-Mg citrate
thiazides
promote Ca2+ reabsoption in the DT decreasing conc. in the lumen
Allopurinol
inhibits purine and uric acid metabolism
Diuretic Resistance (6)
-excessive sodium intake
-reduced bioavailability
-proteinuria, glomerulonephritis
-reduced renal blood flow
-increase Na reabsorption
-ATN
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