treatment of aki

8/17/2019 Treatment of Aki

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TREATMENT OF AKI

Hala Kilany, MD.


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EVALUATE AND TREAT ACCORDING TO ETIOLOGY

PRERENAL:-co!c" #y$o%ol!&ia-a''!'' i'( )ac"o'

-a%oi*: n!$#o"o+ic *', con"a'"&!*ia, ACEi', AR'//

PO0TRENAL:

-!)! "o a oloi'"-i&&!*ia"! !li!) o) "#! o1'"c"ion


3/42

ATN

T#! &o'" co&&on ca'! o) AKI.

T#! "!a"&!n" i' la!ly '$$o"i%!,!la"!* "o co&$lica"ion' o) AKI.


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FLUID AND ELECTROLYTE0

Fli* 1alanc! can 1! &ain"ain!* 1y!$lacin in'!n'i1l! lo''!' 2344-544&l6*7, an* !$lac! &!a'!* lo''!':

-in!-a'"ic *aina!-*ia#!a

li"! )o li"! 8i"# 4.39 'alin!.


5/42

Fli* &ana!&!n" in nonoliic AKI"!n*' "o 1! !a'i!.

T#!'! $a"i!n"' '#ol* !c!i%! a %ol&!o) ;i*< in! %ol&! = in'!n'i1l!lo''!'.


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OLIGURIA

Loo$ *i!"ic': #i# *o'!' IV.-no ol! )o *i!"ic' i) in #y$o%ol!&ia.-con'i*! loo$ *i!"ic' only i)

#y$!%ol!&ia o !*!&a.


7/42

DIURETIC0

0!%!al "#!o!"ical 1!n!>"':- in ca'! o) in"a"1la o1'"c"ion, "#!inc!a'! in "1la ;o8 8ill ? ;'# o"@

o1'"c"!* "1l!'.-loo$ *i!"ic' col* inc!a'! ;o8 an*1y in#i1i"in: Na=-K=-Cl- "an'$o"!

in "#! TALH, *!c!a'! &!*llay O*!&an*.


8/42

DIURETIC0

Con%!'ion )o& oliic "o non-oliicAKI #a' no" 1!!n '#o8n "o *!c!a'!&o"ali"y, 1" i" &ay )acili"a"! ;i* an*

!l!c"oly"!' &ana!&!n".


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METAOLIC COMPLICATION0

Hy$ona"!&ia.2Nl: B5-B39&!6l7

Hy$!(al!&ia.2Nl:.9-9.B &!6l7

Hy$ocalc!&ia.2Nl:.5-B4.&6*l7 Hy$!$#o'$#a"!&ia. 2Nl:. - 3.

&*l7

Hy$!&an!'!&ia.2Nl:B.-.9&6*l7 Hy$!ic!&ia.2Nl:.9-9.5&6*l7

M!"a1olic aci*o'i'.2 Nl HCO:-

&!6l7


10/42

HYPERKALEMIA

NORMAL EKG


11/42

HYPERKALEMIA

R!'"ic"ion o) *i!"ay $o"a''i& Di'con"in! K = '$$l!&!n"' o K =-'$ain

*i!"ic'

K =

-1in*in !'in Loo$ *i!"ic

Glco'! 294 &l' o) 947 =in'lin 2B4JB9 U !la7 IV

0o*i& 1ica1ona"! 294JB44 &! IV7

Calci& lcona"! 2B4 &L' o) B4 'ol"iono%! 9&in7

Dialy'i'.


12/42

METAOLIC ACIDO0I0

ica1on"! IV.

Do'!: 4.9 + 1o*y 8!i#" + HC4-

A""!n"ion: %ol&! o%!loa*


13/42

HYPONATREMIA

a"! !'"ic"ion =- *i!"ic': loo$*i!"ic'.

Dialy'i'


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CARDIOVA0CULAR

Pl&onay !*!&a: -loo$ *i!"ic' -*ialy'i'

Hy$!"!n'ion: -'al" !'"ic"ion -loo$ *i!"ic' -a%oi*: ACEi' an* AR'

P!ica*i"i': -a1'ol"! in*ica"ion )o

*ialy'i' -an"icoala"ion i'con"ain*ica"!*

A#y"#&ia'.


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16/42


17/42


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NEUROLOGIC

A'"!i+i'.

N!o&'cla ii"a1ili"y.

Myoclon'.

0o&nol!nc!.

0!i!'.

Co&a. T!a"&!n": *ialy'i'


19/42

HEMATOLOGIC

An!&ia:-Ta!": H1: BB-B*l-ca'!':!y"#o$oi!"in *!>ci!ncy i' "#! $i&ay ca'!o) ana!&ia a''ocia"!* 8i"# !nal )ail!.

Ey"#o$oi!"in i' $!*o&inan"ly $o*c!* 1y$!i"1la c!ll' in "#! (i*n!y an* i' "#! #o&on!!'$on'i1l! )o &ain"ainin "#! $oli)!a"ion an**i!!n"ia"ion o) !y"#oi* $o!ni"o c!ll' in "#! 1on!

&ao8. Lo'' o) $!i"1la c!ll' l!a*' "o an ina$$o$ia"!ly

lo8 l!%!l o) cicla"in !y"#o$oi!"in in "#! )ac! o)an!&ia.


20/42

OTHER CAU0E0 OF ANEMIA:

Ion *!>ci!ncy

loo* lo'' #!&o#a!

H!&oly'i'

Malinancy: &l"i$l! &y!lo&a

In)!c"ionin;a&&a"ion

Vi"a&in B an* )ola"! *!>ci!ncy P! !* c!ll a$la'ia


21/42

TREATMENT OF ANEMIA

T!a" "#! ca'!.

Ey"#o$oi!"in


22/42

GA0TRO-INTE0TINAL

Na'!a.

Vo&i"in.

l!!*in. T!a"&!n": Dialy'i'


23/42

INFECTIOU0

Pn!&onia.

ac"!!&ia, !.., '!con*ay "o *ialy'i'-ca"#!"! in)!c"ion.

on* in)!c"ion.


24/42

NUTRITIONAL 0UPPORT

AKI i' a '"a"! o) &!"a1olic '"!''.

Ca"a1oli'& o) $o"!in '"o!' "o '$$o"lcon!o!n!'i' can !'l" in &a(!*

&'cl! an* %i'c!al $o"!in 8a'"inan* i' a''ocia"!* 8i"# !+c!'' &o1i*i"yan* &o"ali"y.


25/42

THE FOLLOING RECOMMENDATION0

Po"!in an* non-$o"!in caloi!' '#ol*1! $o%i*!* "o &!!" calcla"!* !n!y!+$!n*i"!, a" a a"! no" "o !+c!!*:

B.96(6* $o"!in in"a(!. To"al $a!n"!al n"i"ion '#ol* 1! i%!n

only "o $a"i!n"':

-'!%!!ly &alnoi'#!*-!+$!c"!* no" "o 1! a1l! "o !a" B3 *ay'

En"!al )!!*in i' $!)!!* "o TPN.

COMPLICATION TREATMENT


26/42


In"a%a'cla Vol&!O%!loa*

R!'"ic"ion o) 'al" 2BJB.9 *ay7 an*8a"! 2B L*ay7

Con'i*! *i!"ic' 2'ally loo$' =-"#iai*!7

Ul"a>l"a"ion

Hy$ona"!&ia R!'"ic"ion o) oal an* in"a%!no' )!!8a"!

Hy$!(al!&ia R!'"ic"ion o) *i!"ay $o"a''i&

Di'con"in! K = '$$l!&!n"' o K =-'$ain *i!"ic'

K =-1in*in !'in

Loo$ *i!"ic

Glco'! 294 &l' o) 947 = in'lin 2B4JB9 U !la7 IV

0o*i& 1ica1ona"! 294JB44 &! IV7

Calci& lcona"! 2B4 &L' o) B4'ol"ion o%! 9 &in7

Dialy'i'#!&o>l"a"ion



27/42


M!"a1olic Aci*o'i' R!'"ic"ion o) *i!"ay $o"!in

0o*i& 1ica1ona"! 2i) HCO- B9

&EL7

Dialy'i'#!&o>l"a"ionHy$!$#o'$#a"!&ia R!'"ic"ion o) *i!"ay $#o'$#a"!

in"a(!

P#o'$#a"! 1in*in a!n"' 2calci&ca1ona"!, calci& ac!"a"!,'!%al!&!7

Hy$ocalc!&ia Calci& ca1ona"! 2i) 'y&$"o&a"ic o'o*i& 1ica1ona"! "o 1!a*&ini'"!!*7

Hy$!&an!'!&ia Di'con"in! &an!'i& con"aininan"aci*'

N"i"ionR!'"ic"ion o) *i!"ay $o"!in 24.(*ay $ "o B.9 (*ay onCVVHD7 9J4 (cal*ay

En"!al o"! o) n"i"ion $!)!!*

D Do'a! A*Q'" all *o'!' )o GFR an* !nal!$lac!&!n" &o*ali"y

A1'ol"! In*ica"ion' )o RRT Clinical !%i*!nc! o) !&iaIn"ac"a1l! %ol&! o%!loa*


28/42

CON0IDERATION0 HEN 0TARTING DIALY0I0

#!"#! o no" "o $o%i*! *ialy'i', an* i)'o, 8#!n, a! )n*a&!n"al !'"ion')acin n!$#oloi'" in &o'" ca'!' o) ARF.

Ini"ia"ion o) *ialy'i'.

Do'! o) *ialy'i'

Mo*ali"y o) *ialy'i' Ty$! o) *ialy'i' &!&1an!.


29/42

DILAY0I0

Gi*!lin!' )o ini"ia"ion o) *ialy'i':B. Oliia 2344 &l6*7. Ania. 0!& c!a"inin! 5- &6*l3. Pl&onay !*!&a n!'$on'i%! "o

con'!%a"i%! "#!a$y9. Hy$!(al!&ia5. 0y&$"o&a"ic !&ia: !nc!$#alo$a"#y,$!ica*i"i'. M!"a1olic aci*o'i'.. C!"ain *' an* alco#ol in"o+ica"ion.


30/42

MODALITY OF DIALY0I0

In"!&i""!n" #!&o*ialy'i'

Con"ino' *ialy'i'


31/42

INTERMITTENT HD


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IHD

Ini"ially '#o": #o', "#!n al"!na"! *ay: -3#o'.

In"!&i""!n" #!&o*ialy'i' 2IHD7 i' c!n"ly

"#! '"an*a* )o& o) "#!a$y 8ol*8i*! )o"!a"&!n" o) ARF in 1o"# in"!n'i%! ca! ni"2ICU7 an* non-ICU '!""in'.

T#! %a'" &aQoi"y o) IHD i' $!)o&!* 'in

'inl!-$a'' 'y'"!&' 8i"# &o*!a"! 1loo* ;o8a"!' 244 "o 94 &L&in7 an* con"!c!n"*ialy'a"! ;o8 a"!' o) 944 &L&in.


33/42

DRAACK0

Al"#o# "#i' &!"#o* i' %!y !ci!n",i" i' al'o a''ocia"!* 8i"# #!&o*yna&icin'"a1ili"y !'l"in )o& "#! la! '#i)"'

o) 'ol"!' an* ;i* o%! a '#o" "i&!.


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MECHANI0M0 OF 0OLUTE TRAN0FER

Di'ion

Con%!c"ion


35/42

DIFFU0IVE CLEARANCE

A !'l" o) an*o& &ol!cla &o"ion

In;!nc!* 1y conc!n"a"ion a*i!n" o)"#! 'ol"! an* i"' Mol!cla 8!i#" a'

8!ll a' 1y "#! &!&1an! $!&!a1ili"y"o "#! 'ol"!


36/42

CONVECTIVE CLEARANCE

a"! &ol!cl!' $a''in "#o# a0PM cay 8i"# "#!& "#! 'ol"!'. T#i' i'call!* "#! ?'ol%!n" *a $#!no&!non@

a"! can 1! &a*! "o &o%! aco'' a0PM 1y "#! a$$lica"ion o) !i"#! a#y*o'"a"ic o an o'&o"ic a*i!n"


37/42

Principle: Solute transfer across

semipermeale memranes

alon! concentration!ra"ients #difusion$ Counter current %o& for

optimi'e" e(cac) Selecti*it):

Lo& #dialysate composition$ E(cac): High or small molecular

weight sustances #urea+creatinine+ electrol)tes+

u,er---$ Low or higher molecular

weight sustances #smallproteins+ me"iators+ etc-$


38/42

C!n"al %!no' ca"#!"!:


39/42

CATHETER IN0ERTION


40/42

CATHETER IN0ERTION

#!n c#oo'in a %!in )o in'!"ion o) a *ialy'i'ca"#!"! in $a"i!n"' 8i"# AKI, con'i*! "#!'!$!)!!nc!' 2No" Ga*!*7:

Fi'" c#oic!: i#" Qla %!inS 0!con* c#oic!: )!&oal %!inS T#i* c#oic!: l!)" Qla %!inS La'" c#oic!: '1cla%ian %!in 8i"# $!)!!nc!

)o "#! *o&inan" 'i*!.#""$:888.(i*n!y-in"!na"ional.o c#a$"! 9.3 4B KDIGOKi*n!y In"!na"ional 0$$l!&!n"' 24B7 , JBB9 B


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TYPE0 OF VA0CULAR ACCE00

Na"i%! AVF


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0yn"#!"ic a)":-can 1! '!* !ali!.-&o! clo""in

-&o! "#o&1o'i'

treatment of aki

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