Acute Kidney Injury (AKI): NCLEX Priorities
AKI: pre-renal vs intrinsic vs post-renal, BUN/creatinine ratio, contrast nephropathy.
AKI is sudden loss of kidney function. NCLEX tests pre-renal vs intrinsic vs post-renal and management.
Categories
Pre-renal: hypoperfusion (dehydration, hypotension, HF). BUN/Cr >20:1. Intrinsic: tubular damage (ATN from ischemia, contrast, nephrotoxins like aminoglycosides). BUN/Cr ~10-15:1. Post-renal: obstruction (BPH, stones, mass).
Diagnosis
Rise in creatinine >0.3 mg/dL in 48h or 1.5× baseline. Decreased urine output.
Management
Treat underlying cause. Avoid nephrotoxins (NSAIDs, contrast, aminoglycosides). Fluid resuscitation for pre-renal. Renal-dose adjust meds. Dialysis for refractory hyperkalemia, acidosis, fluid overload, uremia.
Contrast nephropathy prevention
Hold metformin, hold ACE/ARB if at risk. IV hydration with normal saline before/after. N-acetylcysteine (controversial).
Frequently asked
FENa interpretation?
FENa <1% suggests pre-renal. >2% suggests intrinsic.
Indications for emergent dialysis (AEIOU)?
Acidosis, Electrolyte (K+), Ingestion, Overload, Uremia.
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