Prevention Central in AKI | Lecture Note - Edubirdie

University:
The University Of Western Ontario
Course:
Pathology 3500B | Human Pathology
Academic year:

2023
Views:

56

Pages:

3
Author:

Kyuwon J.

Prevention Central in AKI ● No specific curvature in therapy ● When fibrosis+nephron loss happens… ○ Injury becomes irreversible ○ To avoid and overcome this ■ Injury interrupt it early ● Biomarker will help identify patients prior to creatinine increases ● Prevention still is possible in the stage High risk patients ● Identification of at risk patients ○ Early interventions ■ Sepsis + septic shock ■ Recently had major surgery ● Cardiac ● Vascular ■ ICU admissions ■ CKD ■ Diabetes in elderly ■ Exposure to contrast ● Nephorotoxins ■ Hypovolemia ■ Hypotensions ○ Prevention starts with identifying risk ○ This happens prior to AKI development AKI prevention ● Hemodynamic optimizations ○ Maintaining adequate renal perfusions ○ Avoidance of hypotensions ■ Hypovolemia ○ Use of isotonic crystalloids ■ Balanced solution is preferred ○ Fluid therapy ■ Individualized ■ Avoid overload ○ This is to preserve GFR ○ Preventing Ischemic tubular injury ● Avoid Nephrotoxins ○ Minimization of … ■ NSAIDs ■ Aminoglycosides ■ Amphotericin B ■ High-dose diuretics ● If indicated otherwise… ■ Renewing medication in daily basis ■ Adjusting dose for renal functions ● AKI prevention (contrast) ○ Lowest possible on contrast dose ○ IV hydration before and after ○ Avoiding contrast in 48-72h term ○ Do not use non-essential nephrotoxic drugs ● Monitoring ○ Urine output monitoring ○ Daily creatinine for high-risk patients ■ This may be more frequent ■ Hours, after meal…etc ○ Consideration on biomarkers in ICU ○ Perioperative settings ○ Reduction on urine output, often earliest clinical signs of AKI ● Controlling infection ○ Early stage recognition and treatment of sepsis ○ Antibiotics and source control ○ Must avoid of prolonged inflammatory renal injury

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