The Curbsiders Internal Medicine Podcast

REBOOT #226 Kidney Boy on Acute Kidney Injury: Myths & Musings

26 snips

Aug 12, 2024

Join Dr. Joel Topf, Chief of Nephrology, as he dives into the intricate world of acute kidney injury (AKI). With humor and expertise, he demystifies common myths around nephrotoxicity, including risks tied to vancomycin and NSAIDs. Learn about the critical factors in diagnosing and managing AKI, particularly in high-risk patients. From understanding urine output to navigating the challenges of acute interstitial nephritis, Dr. Topf shares valuable tips for both clinicians and curious minds alike.

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ADVICE

AKI Schema

Categorize AKI as prerenal, postrenal, or intrarenal.
Most AKI cases (70-90%) are prerenal or postrenal, often resolved with fluids and a Foley catheter.

INSIGHT

AKI Biomarkers

Urine output and creatinine remain the most practical markers for AKI.
New biomarkers are perpetually "five years away" and not yet clinically useful.

ADVICE

Initial AKI Management

After diagnosing AKI, determine urine output (oliguric, anuric, non-oliguric).
Establish etiology and address life-threatening electrolyte abnormalities.

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AKI Tips and Tricks from Joel Topf MD, Kashlak’s Chief of Nephrology

Get a grip on acute kidney injury (AKI) with Dr. Joel Topf (AKA @kidney_boy), Kashlak’s Chief of Nephrology! We’ve put together an AKI highlight reel - focusing on practical tips and tricks to help you identify, diagnose and manage AKI, plus how to recognize AIN and random myths and musings on vancomycin, NSAIDS, contrast nephropathy, and the risk of NSF from gadolinium.

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).

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Credits

Written (including CME questions) and Produced by: Cyrus Askin, MD
Infographic by: Cyrus Askin, MD
Cover Art: Kate Grant MBChb, MRCGP
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP
Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com
Guest: Joel Topf, MD

Time Stamps

00:00 Sponsors - VCU Health CE and Pediatrics On Call podcast by APP
00:30 Intro, disclaimer, guest bio
03:00 Guest one-liner, Picks of the Week*: Zoe Keating albums (Cellist); Mrs. America (TV series) on FX; The Last of Us (Videogame);
08:45 Sponsor - Pediatrics On Call podcast by APP
09:15 Definition of acute kidney injury (AKI) and fundamentals
11:00 Cardiorenal syndrome
12:24 Schema for AKI
17:30 Establish an etiology, determine urine output and address electrolyte abnormalities
21:22 AKI in the otherwise-healthy patient;
32:20 Rhabdomyolysis 38:21 Vancomycin
41:43 Acute interstitial nephritis (AIN)
44:52 Contrast induced nephropathy (CIN)
50:37 Gadolinium in AKI and/or CKD
52:53 Timing of dialysis
56:37 AKI in the out-patient setting and how to handle home meds e.g. TMP-SMX, RAAS inhibitors;
62:01 Is Ultrasound necessary in AKI
64:58 Dr. Topf’s take home points and Plug for Seminars in Nephrology
68:45 Outro and Sponsor - VCU Health CE

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