Acute renal failure

Acute renal failureBy :Chua Shiau YingModerator: Dr Nik AzmanLearning objectivesDefinition of acute renal failureAetiologyManagement strategyBiomarkers

Case 145 yrs old woman No known medical illnesspresented to ED with hx of fever and cough 3 daysSOB worsening today

O/E:T:38.3 C,BP:80/40mmHgHR: 120/minRR: 28SPO2: 89%RA. Lungs have bilateral ralesABG : pH:7.26/Paco2:40/PaO2:120/Hco3-:15/lactate 6Initial labs: TWBC 2500 mm3, Hb 10 g/dl, Plt 103,000 mm3;BUSE:Na 134 mEq/L, K 4.0,Cl 100 mEq/L,BUN 4.4mmol/l, Cr 85umol/l, Glucose 7.2mmol/l,albumin 20 g/l.CXR shows patchy infiltrateadmitted into ICUUrine outputTime since admission1st hr2nd hr3rd hr4th hr5th hr6th hrUrine output(ml/hr) 10 15 5 5 10 5Differential diagnosis???

IS THIS AKI

Rifle criteriacategoryGFR criteriaUrine output criteriaRiskGFR reduction >25% or increased creatinine 1.5x50% or increased creatinine 2x

75% or increased creatinine 3x4 weeksESKDComplete loss of renal function > 3mthsKDIGO-AKIN+RIFLEStaging of AKI stage sr creat urine output 11.5-1.9x baseline OR26.5umol/L increase