Professional Documents
Culture Documents
TREATMENT OF AKI
PRERENAL:
-correct hypovolemia
-assess risk factors
-avoid: nephrotoxic drugs, contrast
media, ACEis, ARBs
POSTRENAL:
-refer to a urologist
-immediate relief of the obstruction
ATN
OLIGURIA
DIURETICS
DIURETICS
METABOLIC COMPLICATIONS
Hyponatremia.(Nl: 136-145meq\l)
Hyperkalemia.(Nl:3.5-5.1 meq\l)
Hypocalcemia.(Nl:8.6-10.2mg\dl)
Hyperphosphatemia. (Nl:2.2 - 4.8
mg/dl)
Hypermagnesemia.(Nl:1.7-2.5mg\dl)
Hyperuricemia.(Nl:2.5-5.6mg\dl)
Metabolic acidosis.( Nl HCO3:22-29
meq\l)
NORMAL EKG
HYPERKALEMIA
HYPERKALEMIA
METABOLIC ACIDOSIS
Bicarbonte IV.
Dose: 0.5 x body weight x HC03Attention:
volume overload
HYPONATREMIA
Dialysis
CARDIOVASCULAR
NEUROLOGIC
Asterixis.
Neuromuscular irritability.
Myoclonus.
Somnolence.
Seizures.
Coma.
Treatment: dialysis
HEMATOLOGIC
Anemia:
-Target: Hgb: 11-12g/dl
-causes:erythropoietin deficiency is the primary cause
of anaemia associated with renal failure.
Erythropoietin is predominantly produced by
peritubular cells in the kidney and is the hormone
responsible for maintaining the proliferation and
differentiation of erythroid progenitor cells in the bone
marrow.
Loss of peritubular cells leads to an inappropriately
low level of circulating erythropoietin in the face of
anemia.
Iron deficiency
Blood loss/ hemorrhage
Hemolysis
Malignancy: multiple myeloma
Infection/inflammation
Vitamin B12 and folate deficiency
Pure red cell aplasia
TREATMENT OF ANEMIA
GASTRO-INTESTINAL
Nausea.
Vomiting.
Bleeding.
Treatment: Dialysis
INFECTIOUS
Pneumonia.
Bacteremia, e.g., secondary to dialysiscatheter infection.
Wound infection.
NUTRITIONAL SUPPORT
COMPLICATION
Intravascular Volume
Overload
Hyponatremia
Hyperkalemia
TREATMENT
Restriction of salt (<11.5 g/day) and
water (<1 L/day)
Consider diuretics (usually loops +/thiazide)
Ultrafiltration
Restriction of oral and intravenous free
water
Restriction of dietary potassium
Discontinue K+ supplements or K+sparing diuretics
K+-binding resin
Loop diuretic
Glucose (50 mls of 50%) + insulin (10
15 U regular) IV
Sodium bicarbonate (50100 meq IV)
Calcium gluconate (10 mLs of 10%
solution over 5 min)
Dialysis/hemofiltation
COMPLICATION
TREATMENT
Metabolic Acidosis
Hyperphosphatemia
Hypocalcemia
Hypermagnesemia
Nutrition
Drug Dosage
Absolute Indications for RRT
Initiation of dialysis.
Dose of dialysis
Modality of dialysis
Type of dialysis membrane.
DILAYSIS
MODALITY OF DIALYSIS
Intermittent hemodialysis
Continuous dialysis
INTERMITTENT HD
IHD
DRAWBACKS
Diffusion
Convection
DIFFUSIVE CLEARANCE
CONVECTIVE CLEARANCE
Principle:
Solute transfer across
semipermeable membranes
along concentration
gradients (diffusion)
Counter current flow for
optimized efficacy
Selectivity:
Low (dialysate composition)
Efficacy:
High for small molecular
weight substances (urea,
creatinine, electrolytes,
buffer...)
Low for higher molecular
weight substances (small
proteins, mediators, etc.)
CATHETER INSERTION
CATHETER INSERTION
Native AVF
Synthetic graft:
-can be used earlier.
-more clotting
-more thrombosis