Sudden decline in renal function over hours/days, marked by ↑ BUN/Creatinine and often oliguria (<400 mL/day).

1. Initiation (insult). 2. Oliguric (low UOP, ↑ labs). 3. Diuretic (high UOP, labs start to fall). 4. Recovery.

Reduced renal perfusion: Hypovolemia, hemorrhage, heart failure, shock, renal artery stenosis. Often reversible.

Direct kidney damage: Nephrotoxins (contrast, NSAIDs, aminoglycosides), glomerulonephritis, rhabdomyolysis, sepsis.

Obstruction of urine outflow: BPH, stones, tumors, strictures. Relieving obstruction can reverse AKI.

>20:1 suggests Prerenal cause (e.g., dehydration). ~10:1 suggests Intrarenal cause (e.g., ATN).

Hyperkalemia, Hyperphosphatemia, Hypocalcemia, Metabolic Acidosis (kidneys can't excrete acid).

Hyperkalemia Treatment

EKG changes? 1. IV Calcium Gluconate (cardioprotective). 2. Insulin + D50. 3. Sodium Bicarbonate. 4. Kayexalate.

Sodium polystyrene sulfonate. Cation exchange resin (oral/enema). Exchanges Na+ for K+ in gut. Onset slow (6h).

Fluids Oliguric Phase

Restrict fluid to "I&O + 500 mL" (insensible losses). Watch for fluid overload (crackles, edema, HTN).

Restrict K+, P04-, Na+. Protein restriction based on severity (0.6-0.8 g/kg). High carbohydrate for calories.

Refractory fluid overload, hyperkalemia unresponsive to meds, severe acidosis, uremic symptoms (pericarditis, encephalopathy).

Avoid NSAIDs, aminoglycosides, IV contrast if possible. Ensure hydration before contrast studies.

Adequate hydration, monitor I&O in high-risk patients, use N-acetylcysteine or sodium bicarb pre-contrast in some cases.

Hourly urine output monitoring. Report <30 mL/hr for 2+ hours. Daily weights (1 kg = 1 L fluid).

Uremia and impaired immunity increase infection risk. Monitor for subtle signs, practice strict aseptic technique.

Manifestations: Nausea, pruritus, pericardial friction rub, confusion, asterixis (flapping tremor).

Recovery Phase Warning

During diuresis, massive fluid/electrolyte loss can occur. Monitor for dehydration, hyponatremia, hypokalemia.

Contrast-Induced Nephropathy Prevention

IV hydration with 0.9% NS before & after. Use low/iso-osmolar contrast. Consider N-acetylcysteine.

"I GET PAID": Infection, Glomerulonephritis, Exposure to toxins, Tumor lysis, Pyelonephritis, ATN, Ischemia, Drugs.

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Acute Kidney Injury

Question	Answer
Patho	Sudden decline in renal function over hours/days, marked by ↑ BUN/Creatinine and often oliguria (<400 mL/day).
Phases	1. Initiation (insult). 2. Oliguric (low UOP, ↑ labs). 3. Diuretic (high UOP, labs start to fall). 4. Recovery.
Prerenal Causes	Reduced renal perfusion: Hypovolemia, hemorrhage, heart failure, shock, renal artery stenosis. Often reversible.
Intrarenal Causes	Direct kidney damage: Nephrotoxins (contrast, NSAIDs, aminoglycosides), glomerulonephritis, rhabdomyolysis, sepsis.
Postrenal Causes	Obstruction of urine outflow: BPH, stones, tumors, strictures. Relieving obstruction can reverse AKI.
BUN:Cr Ratio	>20:1 suggests Prerenal cause (e.g., dehydration). ~10:1 suggests Intrarenal cause (e.g., ATN).
Electrolytes	Hyperkalemia, Hyperphosphatemia, Hypocalcemia, Metabolic Acidosis (kidneys can't excrete acid).
Hyperkalemia Treatment	EKG changes? 1. IV Calcium Gluconate (cardioprotective). 2. Insulin + D50. 3. Sodium Bicarbonate. 4. Kayexalate.
Kayexalate	Sodium polystyrene sulfonate. Cation exchange resin (oral/enema). Exchanges Na+ for K+ in gut. Onset slow (6h).
Fluids Oliguric Phase	Restrict fluid to "I&O + 500 mL" (insensible losses). Watch for fluid overload (crackles, edema, HTN).
Nutrition	Restrict K+, P04-, Na+. Protein restriction based on severity (0.6-0.8 g/kg). High carbohydrate for calories.
Dialysis Indications	Refractory fluid overload, hyperkalemia unresponsive to meds, severe acidosis, uremic symptoms (pericarditis, encephalopathy).
Nephro Meds Avoid	Avoid NSAIDs, aminoglycosides, IV contrast if possible. Ensure hydration before contrast studies.
Prevention Strategy	Adequate hydration, monitor I&O in high-risk patients, use N-acetylcysteine or sodium bicarb pre-contrast in some cases.
I&O	Hourly urine output monitoring. Report <30 mL/hr for 2+ hours. Daily weights (1 kg = 1 L fluid).
Infection	Uremia and impaired immunity increase infection risk. Monitor for subtle signs, practice strict aseptic technique.
Uremia	Manifestations: Nausea, pruritus, pericardial friction rub, confusion, asterixis (flapping tremor).
Recovery Phase Warning	During diuresis, massive fluid/electrolyte loss can occur. Monitor for dehydration, hyponatremia, hypokalemia.
Contrast-Induced Nephropathy Prevention	IV hydration with 0.9% NS before & after. Use low/iso-osmolar contrast. Consider N-acetylcysteine.
Mnemonic	"I GET PAID": Infection, Glomerulonephritis, Exposure to toxins, Tumor lysis, Pyelonephritis, ATN, Ischemia, Drugs.

Created by: Wasurenboh

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