acute kidney injury and kidney failure

This mind map of acute kidney injury and renal failure introduces the concepts, causes, clinical manifestations, diagnosis, differential diagnosis, treatment, prevention, etc.

Edited at 2024-04-02 18:09:19

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acute kidney injury and kidney failure

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acute kidney injury and kidney failure

concept

Renal function decreases in a short period of time (a few hours or days), that is, the solute clearance capacity and glomerular filtration rate decrease, resulting in a series of comprehensive symptoms such as water electrolyte and acid-base balance disorders and the accumulation of nitrogen metabolites. levy

Cause

prerenal

acute hypovolemia

Heavy bleeding

Large amounts of fluid loss from the digestive tract or skin

Liquid transfers to the third gap

excessive diuresis

Decreased cardiac output

acute myocardial infarction

severe cardiac arrhythmia

congestive heart failure

pulmonary embolism

Reduction in effective circulating blood volume or redistribution of blood flow

severe sepsis

allergic reaction

hepatorenal syndrome

Increased renal vascular resistance

drug factors

Renal vascular disease

renal

renal ischemia

Heavy bleeding

septic shock

Serum allergic reaction

nephrotoxicity

Aminoglycoside antibiotics

heavy metal

Biological poisons

Organic solvents

radiocontrast agent

Postrenal

Water accumulation above the obstruction

Bilateral kidneys, ureters

Pelvic tumor compresses ureter

Bilateral upper urinary tract hydrops

bladder stones, tumors

prostatic hyperplasia, prostate tumor

Urethral stricture

clinical manifestations

Oligouria (no urine) period

Oliguria (no urine)

Oligouria: 400ml/d, anuria: 100ml/d

progressive azotemia

Water, electrolyte and acid-base balance disorders

Too much water

hyperkalemia

hyperphosphatemia

Hypermagnesemia

Hyponatremia

metabolic acidosis

systemic complications

Cardiovascular System

Hypertension, heart failure, arrhythmia, pericarditis

nervous system

Fatigue, low energy, lack of consciousness, drowsiness, irritability, and even coma

digestive system

Nausea, vomiting, loss of appetite, abdominal pain, diarrhea, gastrointestinal bleeding, jaundice

DIC, anemia

polyuria period

During the 7-14 days of the oliguria and anuria period, the urine output increases to 800ml/d, which is the beginning of the polyuria period. It usually lasts for 14 days, and the urine output can reach more than 3000ml per day.

recovery period

diagnosis

History and physical examination

Urine test

Hemolysis or soft tissue damage

soy sauce colored urine

Prerenal ARF

Concentrated urine, increased urine specific gravity and osmotic pressure

Renal ARF

Isotonic urine, urine specific gravity is 1.010-1.014

A large number of red blood cell casts and proteins

acute glomerulonephritis

white blood cell casts

acute pyelonephritis

wide brown tube

Renal failure: acute tubular necrosis

blood test

Blood test

Significant increase in eosinophils

acute interstitial nephritis

mild to moderate anemia

fluid retention

Dynamic monitoring of serum acid-base and electrolyte levels

Dynamic monitoring of blood urea nitrogen, creatinine and creatinine clearance

AKI early diagnostic markers

kidney biopsy

Renal parenchymal acute renal failure of unknown etiology

Differential diagnosis

ATN and prerenal oliguria

Fluid rehydration experiment

There was volume depletion and fluid loss before the onset of the disease. Prerenal oliguria should be considered if the physical examination reveals dry skin and mucous membranes, hypotension, and unclear jugular vein filling.

ATN oliguric phase and functional AKI

ATN oliguric phase

Urinary sodium greater than 20mmol/L

Urine sediment microscopy: Transparent, granular, cell casts, Red blood cells, white blood cells, degenerated and necrotic epithelial cells

Functional AKI

Urine specific gravity greater than 1.020 Urine osmotic pressure is greater than 500mmol/L

ATN and postrenal urinary tract obstruction

Postrenal urinary tract obstruction

Commonly seen in urinary system stones, tumors, prostatic hypertrophy, sudden anuria, renal colic and positive percussion pain in the kidney area.

treat

Strengthen fluid management and maintain fluid balance

Live within your means

Normal people urinate 1000-1500ml/d

For every 1 degree Celsius increase in body temperature of a febrile patient, increase the amount of fluid administered by 100ml

Maintain internal environment stability and regulate electrolyte and acid-base balance

control infection

Actively deal with infection focus

Take various measures to prevent catheter-related infections

When choosing antibiotics, be careful to avoid nephrotoxicity and potassium-containing preparations

renal replacement therapy

Hemodialysis

hemofiltration

continuous renal replacement therapy

peritoneal dialysis

Actively treat the primary disease and prevent various complications

Nutritional support

prevention

Maintain renal perfusion pressure

cardiac output

mean arterial pressure

vascular volume

Avoid nephrotoxic drugs

Aminoglycoside antibiotics

heavy metal

Organic solvents

Biological poisons

control infection

Important measures to prevent AKI

Actively search for the source of infection

Completely eliminate infection focus

Rational use of antibiotics

Prevent hospital infections

Remove nephrotoxic substances

Aggressive fluid resuscitation

Reduce the nephrotoxicity of myoglobinuria

Prevent AKI

Prevent contrast-induced kidney injury

Strictly limit the amount of contrast agent used

Use non-ionic isotonic contrast media

hydration therapy