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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.
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acute kidney injury and kidney failure
- One Hundred Years of Solitude Character Relationship Chart
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- One Hundred Years of Solitude Character Relationship Chart
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- Project Management Process Template
Project management is the process of applying specialized knowledge, skills, tools, and methods to project activities so that the project can achieve or exceed the set needs and expectations within the constraints of limited resources. This diagram provides a comprehensive overview of the 8 components of the project management process and can be used as a generic template for direct application.
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- Outline
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