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  • Image not available. Risk, Injury, Failure, Loss of Kidney Function, and End-Stage Renal Disease (RIFLE) and Acute Kidney Injury Network (AKIN) criteria are two classification systems used to stage the severity of AKI. Both RIFLE and AKIN classes are based on separate criteria for serum creatinine (Scr) and urine output.
  • Image not available. Acute kidney injury (AKI) is a common complication in the hospitalized patient and is associated with a high mortality rate.
  • Image not available. AKI is predominantly categorized based on the anatomical area of injury or malfunction: (a) prerenal–decreased renal blood flow, (b) intrinsic–a structure within the kidney is damaged, and (c) postrenal–an obstruction is present within the urine collection system.
  • Image not available. Conventional formulas used to calculate the glomerular filtration rate (GFR) and creatinine clearance should not be used to estimate renal function in patients with AKI. Instead, a change in Scr from baseline and urine output information are more useful in determining the trend and severity of AKI. Currently, several novel biomarkers are being explored to aid in early detection and outcome prediction of AKI.
  • Image not available. Prevention is key; there are very few therapeutic options for the management of established AKI.
  • Image not available. Supportive management remains the primary approach to prevent or reduce the complications associated with severe AKI. Supportive therapies include renal replacement therapies (RRTs), nutritional support, avoidance of nephrotoxins, and blood pressure and fluid management.
  • Image not available. For those patients with prolonged or severe AKI, RRTs are the cornerstone of support and facilitate an aggressive approach to fluid, electrolyte, and waste management.
  • Image not available. Diuretic resistance is a common phenomenon in the patient with severe AKI and can be addressed with aggressive sodium restriction, combination diuretic therapy, or a continuous infusion of a loop diuretic.
  • Image not available. Drug-dosing regimens for AKI patients receiving intermittent hemodialysis (IHD) are predominantly extrapolated from data derived from patients with chronic kidney disease (CKD); however, important pharmacokinetic differences exist in patients with severe AKI that should be considered.
  • Image not available. Drug-dosing guidelines for AKI patients receiving continuous renal replacement therapies (CRRTs) are poorly characterized, and individualized doses may need to be determined by estimating the clearance of medications associated with a high risk of toxicity by the patient and the CRRT procedure.

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Upon completion of the chapter, the reader will be able to:

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  • 1. Identify patients at high risk of developing acute kidney injury (AKI).
  • 2. Describe the Risk, Injury, Failure, Loss of Kidney Function, and End-Stage Renal Disease (RIFLE) and Acute Kidney Injury Network (AKIN) classification systems for AKI.
  • 3. Describe the pathophysiology and the most common causes of prerenal, intrinsic, and postrenal AKI.
  • 4. Determine the type of AKI a patient is experiencing from an assessment of the patient’s history, as well as physical and laboratory findings.
  • 5. Discuss the pros and cons of conventional (i.e., serum creatinine and glomerular filtration rate) and novel markers of kidney function as they pertain to a patient with AKI.
  • 6. Recommend measures to minimize the development of AKI for a patient receiving a contrast agent.
  • 7. Distinguish effective versus ...

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