1 / 97

Acute Kidney Injury (AKI)

Acute Kidney Injury (AKI). Rubin S Gondodiputro. “A NEW CONCEPT THAT STILL MOVES and CHANGES”. OBJECTIVES. DEFINITION and CLASIFICATION of AKI EPIDEMIOLOGY of AKI ETIOLOGY and DIAGNOSIS of AKI PATHOPHYSIOLOGY of AKI BIOMARKER of AKI. DEFINITION and CLASIFICATION AKI. Definitions.

grace
Download Presentation

Acute Kidney Injury (AKI)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Acute Kidney Injury (AKI) Rubin S Gondodiputro

  2. “A NEW CONCEPT THAT STILL MOVES and CHANGES”

  3. OBJECTIVES DEFINITION and CLASIFICATION of AKI EPIDEMIOLOGY of AKI ETIOLOGY and DIAGNOSIS of AKI PATHOPHYSIOLOGY of AKI BIOMARKER of AKI

  4. DEFINITION and CLASIFICATION AKI

  5. Definitions Acute Renal Failure Acute Kidney Injury

  6. The need for Defining ARF • Acute renal occurs in 5-20% of critically ill patients with a mortality of 28-90% • Conclusion : - We have no idea what ARF is! • At least 30 definitions of ARF are in use

  7. Definisi GGA berdasarkan beberapa penelitian Keterangan : Scr= Serum Creatinin. BUN = Blood Urea Nitrogen. LFG = Laju Filtrasi glomeruli

  8. AKI: A Common, Serious Problem • AKI is present in 5% of all hospitalized patients, and up to 50% of patients in ICUs • The incidence is increasing -globally • Mortality rate 50 - 80% in dialyzed ICU patients– 4 Million die each year of AKI • AKI requiring dialysis is one of the most important independent predictors of death in ICU patients • 25% of ICU dialysis survivors progress to ESRD within 3 years

  9. Issues in Design of Clinical Trials in ARF • Heterogeneity of patient population • Effect of co-morbidty and illness on outcome • Large variations in clinical practice • Lack of a standarddized definition of ARF Metha et al, J Am Soc Nephrol 2002

  10. Diagnosis of AKI isOften Delayed • Elevation in serum creatinine is the current gold standard, but this is problematic • Normal serum creatinine varies widely with age, gender, diet, muscle mass, muscle metabolism, medications, hydration status • In AKI, serum creatinine can take several days to reach a new steady state

  11. Proposed Diagnostic Criteria for AKI

  12. Perkiraan kadar kreatinin serum berdasarkan kelompok usia dan ras

  13. Peningkatan kadar serum kreatinin ( mg/dl) disesuaikan dengankriteria RIFLE

  14. Kriteria RIFLE berdasarkan urin output (UO) dan berat badan penderita Roesli R. 2007

  15. Prediksi prognosis dan kematian berdasarkan kriteria RIFLE HR = hazard ratio; R= risk ; I = Injury ; F = failure

  16. EPIDEMIOLOGY

  17. Natural History of AKI

  18. ETIOLOGY or COMMON CAUSES OF AKI

  19. AKI: Common Causes • Ischemia (60%): cardiovascular disease, cardiac surgery, abdominal surgery, shock, sepsis • Nephrotoxins(30%): antibiotics, contrast, chemotherapy, anti-rejection, NSAIDs These causes also frequently lead to sub-clinical renal injury,a vastly underestimated problem

  20. Etiology of AKI

  21. COMMON CAUSES/ETIOLOGY OF AKI

  22. PATHOPHYSIOLOGY

  23. Pathophysiology of AKICurrent Knowledge from Experimental models 􀂆 AKI can result from different triggers 􀂆 Kidney response to injury is time dependent and occurs immediately following injury. 􀂆 Response can be characterized by measurement of various markers reflecting activation of different mechanisms and pathways 􀂆 Based on the appearance of various markers it is possible to identify the site of injury, the nature of the response and describe the stage of the disease.

  24. Pathophysiology of AKI • Functional alterations lead to injury  Failure of autoregulation • Injury precedes functional change  Direct Nephrotoxicity  Ischemia Reperfusion  Inflammation • Injury and functional change are concurrent  Complete vascular occlusion

  25. Etiology of AKI

  26. PATHOPHYSIOLOGY of PRERENAL AKI

  27. PATHOPHYSILOGY AKI

  28. Intrarenal mechanisms for autoregulation of GFR

  29. Intrarenal mechanisms for autoregulation of GFR

  30. Intrarenal mechanisms for autoregulation of GFR

More Related