Clinical vignette VIII Multi-organ failure

Reem Alyahya212522156

introduction

Mona Acute

abdominal pain

Resuscitated

Day3:deteriorated

Objective

How to differentiate between renal and

pre-renal causes of AKI?

Acute kidney injury

Abrupt deterioration in parenchymal renal

function, which is usually reversible over a

period of days or week.

Classification

Pre-renal

Renal

Post-renal

Pre- renal :

In pre-renal uremia, there is impaired blood

perfusion to the kidneys. Usually the kidney is able

to maintain GF close to normal despite wide

variation in renal perfusion.

The most common form of AKI

Causes include:

Volume depletion

Decreased cardiac output

Systemic vasodilatation

Renal vasoconstriction

Drugs like NSAIDs and ACEI

Renal :

Structural injury in the kidney is the hallmark of

renal AKI , it’s the second most common form of

AKI after pre-renal causes.

And its most commonly due to acute tubular

necrosis (ATN)

Causes include:

Diseases involving

renal vessels

Glomerul-onephritis

Tubular (ischemic ,

nephrotoxic) Interstitial

How to differentiate?

HistoryPhysical

examination

Laboratory criteria

History

Pre-renal

Volume loss

Heart failure

sepsis

Drug use

Renal

Prolonged hypotension or

hypovolemia

Nephrotoxic drugs

Symptoms GN

Physical examination

Pre-renal

tachycardia

Low JVP

Systemic/orthostatic hypotension

Manifestations of hypovolemia

Clinical picture of Heart failure.

Renal

Manifestations GN

Manifestations of vascular

or interstitial disease

Laboratory criteria

conclusion

AKI is an abrupt deterioration in parenchymal renal

function, which is usually reversible.

The causes can be classified into: pre-renal, renal and

post-renal

We can differentiate between these forms by the way of

: history, physical examination and laboratory criteria.

Reference

Kumar p, Clark M. Clinical medicine. Eighth edition. 2012

Thank you

Any questions?