ACE-inhibitors, Angiotensin receptor blockers (ARBs).nafcillin (can rarely cause interstitial nephritis). Acyclovir, ganciclovir, valacyclovir, valganciclovir, foscarnet.Aminoglycosides, Colistimethate (Colistin).The vast majority of these patients (99.7% overall) won't require dialysis.Non-oliguric renal failure (elevated creatinine with normal urine output).However, <12 hours of oliguria isn't necessarily a disaster – especially if the creatinine remains stable. Oliguria should be taken seriously and evaluated adequately.In that situation, creatinine may overestimate the renal function. ⚠️ Be careful however, because sometimes patients maintain a stable creatinine from a dilutional effect, due to receiving lots of intravenous fluid.This may often represent “pre-renal” renal failure – the kidney is compensating for hypoperfusion by reducing urine output, but is continuing to function adequately.These patients rarely required dialysis, unless oliguria is profound (Stage 3).Isolated oliguria (low urine output with stable creatinine).( 25568178) Some specific types bear mention: Prognosis depends on changes in urine output and creatinine (figure above).More detailed understanding of types of AKI KDIGO criteria for acute kidney injury (assign based on most worrisome feature) Hold antihypertensives if soft Bp (especially negative inotropes).Consider bicarbonate for uremic metabolic acidosis.Otherwise: sevelamer 800 mg TID with meals.In hypocalcemia: calcium carbonate or calcium acetate (~600 or ~667 mg TID with meals).D/C potassium supplementation, potassium-sparing diuretics, or PRN potassium orders (hold potassium unless K6 mg/dL. ![]() Dose-adjust renally cleared medications.Management of AKI treat any identifiable cause(s) □ medication management If abdominal CT scan was recently done for another reason, this is adequate to exclude hydronephrosis.Immediate bedside ultrasonography may expedite diagnosis (don't forget to look at the bladder).However, this may provide additional information (e.g. The main role is exclusion of hydronephrosis.Uric acid if concern for tumor lysis syndrome.vancomycin, aminoglycoside, cyclosporine, tacrolimus). ![]()
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