AKI » Department of Anesthesiology » College of Medicine

Renal Replacement THerapy

Acute Kidney Injury

*Please take the quiz below the video to receive credit.

Objectives

Identify the importance of kidney health on outcomes
Describe Key scientific evidence behind new AKI biomarkers
Identify areas for implementation of new biomarkers in clinical practice

Articles

Discovery and validation of cell cycle arrest biomarkers in human acute kidney injury
Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary

Lecture

Quiz

Name(Required)

First Last

1. Acute kidney injury is a clinical syndrome with rapid deterioration over hours to days characterized by:(Required)

a. Oliguria

b. Anuria

c. Accumulation of metabolic waste products

d. Isolated increase in serum creatinine

2. According to the criteria set by the organization KDIGO, AKI is defined by which of the following?(Required)

a. Increase in SCr by > 0.3 mmg/dl within 48 hrs

b. Increase in SCr to > 1.5 times baseline which is known to have occurred within the last 7 days prior

c. Urine volume < 0.5ml/kg/h for 6 hours

d. All of the above can be used to define AKI

3. True or False: Acute kidney disease which does not resolve in less than 90 days is then characterized as chronic kidney disease.(Required)

True

False

4. The kidney filters the entire plasma volume how often?(Required)

a. Once daily

b. Every 30 minutes

c. Every 60 minutes

d. Every four hours

5. True or False, Biomarkers can be used as a diagnostic test for AKI?(Required)

True

False

6. Which of the following are identifiable risk factors for the development of AKI?(Required)

a. Age

b. Prolonged hypotension in the OR

c. Sepsis

d. Exposure to IV contrast

e. B and D

f. All of the above

7. According to the AKIN criteria for AKI, a patient exhibiting a doubling of their creatinine or urine output < 0.5cc/hr for 12 hours meets criteria for:(Required)

a. Stage 1 AKI

b. Stage 2 AKI

c. Stage 3 AKI

d. Does not meet criteria for AKI

8. After completing the AKI risk stratification algorithm, what score should trigger sending a Nephrocheck test?(Required)

a. Greater than or equal to 2

b. Greater than or equal to 3

c. Greater than or equal to 4

d. Greater than or equal to 5

9. A TIMP2*IGFBP7 level of 2.5 indicates which of the following:(Required)

a. The patient is at low risk for developing AKI

b. The patient is at moderate to high risk for developing AKI

c. The patient is at very high risk of developing AKI

d. The patient has AKI

10. True or False. In addition to the previously established criteria defined by KDIGO, renal biomarkers such as TIMP2 and IGFBP7 can also be used to diagnose AKI.(Required)

True

False

Renal Replacement Therapy

*Please take the quiz below the video to receive credit.

Objectives

Understand the definition of AKI and describe the indications for initiating renal replacement therapy.
Compare and contrast the various methods of renal replacement therapy.
Understand complications associated with various methods of renal replacement therapy and how to manage those complications.

Articles

Serum sodium shift in hyponatremic patients undergoing liver transplantation: A retrospective cohort study
Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit.

Lecture

Quiz

Name(Required)

First Last

1. All of the following can be used to define AKI except:(Required)

a. Increase in SCr by ≥ 0.3mg/dL within 48 hours

b. Increase in SCr to ≥ 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days

c. Urine volumes < 0.5 ml/kg/h for 6 hours

d. Increase in BUN of > 30% in 24 hours

2. What percent of all critically ill patients will require some type of renal replacement therapy?(Required)

a. 1-2%

b. 4-5%

c. 10-15%

d. 25-30%

3. Indications for renal replacement therapy include all of the following except:(Required)

a. Acidosis

b. Electrolyte imbalances

c. Toxins

d. Volume overload

e. Hepatic Encephalopathy

4. True or False: Hemodialysis uses convection to remove unwanted molecules from the blood.(Required)

True

False

5. Movement of solute molecules from a solution of higher concentration to that of a lower concentration through a semi-permeable membrane describes the principle of which of the following:(Required)

a. Convection

b. Diffusion

c. Osmosis

d. Ultrafiltration

6. True or False: CVVH is preferred to Hemodialysis in hypotensive patients due to is ability to create slower osmolar and fluid shifts while providing appropriate clearances.(Required)

True

False

7. All of the following are true of CVVH except:(Required)

a. The higher the ultrafiltration rate, the greater the solute clearance,

b. It removes middle sized molecules

c. Convective transport is independent of solute concentration gradients across the membrane

d. It requires a similar but larger amount of dialysate than hemodialysis

e. It is capable of removing many mediators of sepsis

8. In general, what UF rate should be chosen for most volume-overloaded patients given their vascular refilling rate?(Required)

a. 3ml/kg/hr

b. 5ml/kg/hr

c. 7ml/kg/hr

d. 10ml/kg/hr

9. Citrate toxicity manifests itself with signs and symptoms of which of the following:(Required)

a. Hyperkalemia

b. Hypercarbia

c. Hyponatremia

d. Coagulopathy

e. Hypocalcemia

10. Keeping the filtration fraction less than 25% reduces the chances of which of the following:(Required)

a. Clotting

b. Acidosis

c. Hypothermia

d. Platelet dysfunction