LESION

RENAL
AGUDA
• DRA CECILIA MORENO
URGENCIOLOGA PROFESORA
TITULAR
• DR AVEL ROMAN NEFROLOGO
• DR SERGIO CRUZ R1 UMQ
 DEFINICION
EPIDEMIOLOGIA
DEFINIR Y ETIOLOGIA
CONOCER
: FISIOPATOLOGIA
CLASIFICACION
TRATAMIENTO
 • INCREMENTO RAPIDO EN LA
CREATININA SERICA EN <7 DIAS O
DEFINICION DISMINUCION DEL GASTO URINARIO EN
<48 HRS

1. Marlies Ostermann , Rinaldo Bellomo , Emmanuel A. Burdmann. Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO)
Conference. kidney international. 2020;98:294–304.
Farrar A. Acute kidney injury. Nurs Clin North Am.
2018;53(4):499–510.
 INCIDENCIA DE 10-15% ENPACIENTES
HOSPITALIZADOS
HASTA EL 50% EN PACIENTES DE UCI

EPIDEMIOLO PRINCIPALES MOTIVOS DE IC

INTRAHOSPITALARIO A NEFROLOGIA
GIA
MORTALIDAD DEL 60% EN LRA CON
NECESIDAD DE HD
SEPSIS, DROGAS Y IC DESCOMPENSADA
ETIOLOGIAS ASOCIADAS COMUNES
1. Marlies Ostermann , Rinaldo Bellomo , Emmanuel A. Burdmann. Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO)
Conference. kidney international. 2020;98:294–304. 2.Ronco C, Bellomo R, Kellum JA. Acute kidney injury. Lancet. 2019;394(10212):1949–64. 3 Farrar A. Acute kidney injury. Nurs Clin North
Am. 2018;53(4):499–510.
ETIOLOGIA

2. Ronco C, Bellomo R, Kellum JA. Acute kidney injury. Lancet. 2019;394(10212):1949–64.

3. Farrar A. Acute kidney injury. Nurs Clin North Am. 2018;53(4):499–510.
 FISIOPATOLOGIA PRE-RENAL
25% GC O 1200
HIPOVOLEMIA ML/MIN

BAJA TFG SIN

DAÑO
ESTRUCTURAL
BAJA PERFUSION RENAL
DAÑO A ORGANO
(ISQUEMIA, NTA)

ACTIVACION DE SRAA
MAL
FUNCIONAMIENTO

PRESION HIDROESTATICA
INTRAGLOMERULAR ERC
DISMINUIDA

2. Ronco C, Bellomo R, Kellum JA. Acute kidney injury. Lancet. 2019;394(10212):1949–64.3. Farrar A. Acute kidney injury. Nurs Clin North Am. 2018;53(4):499–510.
 TIPO 1 SD CARDIORENAL
AGUDO

TIPO 2 SD CARDIO RENAL

CRONICO

TIPO 3 SD RENOCARDIACO
AGUDO

TIPO 4 SD RENOCARDIACO
CRONICO

TIPO 5 SD CARDIORENAL
SECUNDARIO

7. Kumar U, Wettersten N, Garimella PS. Cardiorenal syndrome: Pathophysiology. Cardiol Clin. 2019;37(3):251–65. 2. Ronco C, Bellomo R, Kellum JA. Acute kidney injury. Lancet.
2019;394(10212):1949–64.
 SEPSIS

PERDIDA DE
RESISTENCIAS
VASCULARES

HIPOPERFUSION PRE Y
RENAL

CITOCINAS Y LEUCOCITOS
LIDERAN DAÑO TISULAR

DAÑO ESTRUCTURAL Y
EDEMA

6. Poston JT, Koyner JL. Sepsis associated acute kidney injury. BMJ. 2019;364:k4891.3. Farrar A. Acute kidney injury. Nurs Clin North Am. 2018;53(4):499–510.2. Ronco C,
Bellomo R, Kellum JA. Acute kidney injury. Lancet. 2019;394(10212):1949–64.
2. Ronco C, Bellomo R, Kellum JA. Acute kidney injury. Lancet. 2019;394(10212):1949–64.3. Farrar A. Acute kidney injury. Nurs Clin North Am. 2018;53(4):499–510.
FISIOPATOLOGIA
INTRINSECO
GLOMERULO

• GLOMERULONEFRITIS, LES, SARCOIDOSIS

INTERSTICIO

• ALERGIAS, INFECCIONES, DROGAS

TUBULOS

• ISQUEMICOS O NEFROTOXICOS

VASCULATURA

3. Farrar A. Acute kidney injury. Nurs Clin North Am. 2018;53(4):499–510.

1. Marlies Ostermann , Rinaldo Bellomo , Emmanuel A. Burdmann. Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO)
Conference. kidney international. 2020;98:294–304.6. Poston JT, Koyner JL. Sepsis associated acute kidney injury. BMJ. 2019;364:k4891.
FISIOPATOLOGIA POST RENAL

OBSTRUCCION
GENERA AUMENTO
DE LA PRESION
INTRATUBULAR
DISMINUYENDO TFG

OBSTRUCCION
FUNCIONAL OBSTRUCCION DEL
• VEJIGA NEUROGENICA, FLUJO
LITOS RENALES, • HPB, Ca PROSTATA, CaCu,
COAGULOS RENALES, RETOPERITONEO
NECROSIS PAPILAR

3. Farrar A. Acute kidney injury. Nurs Clin North Am.

2018;53(4):499–510.
CLASIFICACI
ON

2. Ronco C, Bellomo R, Kellum JA. Acute kidney injury.

Lancet. 2019;394(10212):1949–64.
6. Poston JT, Koyner JL. Sepsis associated acute kidney injury. BMJ. 2019;364:k4891.
2. Ronco C, Bellomo R, Kellum JA. Acute kidney injury. Lancet. 2019;394(10212):1949–64.
 • CORRECCION DE LA CAUSA
• CORREGIR VOLUMEN
TRATAMIEN • PRUEBA DE ESTRÉS CON FUROSEMIDA
TO • CRITERIOS DE DIALISIS EN AGUDO
• TRR
 TIPOS DE SOLUCIONES
CRISTALOIDES
• NaCl.09%
• HARTMAN
• RINGER LACTATO
• PLASMLYTE

COLOIDES
• ALBUMINA
• ALMIDONES
• GELATINAS
 • CRUZAN FÁCILMENTE LA MEMBRANA SEMIPERMEABLE
CRISTALOIDE • ALTAS CONCENTRACIONES DE NA Y CL

SOLUCIONES ISOTÓNICAS
• EVITAN LRA, MENOR TERAPIA DE
SUSTITUCIÓN, MENOR COMPLICACIÓN POST
CIRUGIA. HIPERLACTEMIA, ALCALOSIS
METABOLICA, CARDIOTOXICIDAD

SOLUCIONES HIPERTÓNICAS
• USADAS EN ELEVACIÓN DE LA PRESIÓN
INTRACRANEAL, POCA EVIDENCIA EN EL USO
EN SEPSIS

SOLUCIONES HIPOTÓNICAS
• GLUCOSADOS

1. Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med. 2013;369(13):1243–51.2. Casey JD, Brown RM, Semler MW. Resuscitation fluids. Curr Opin Crit Care. 2018;24(6):512–8. 2. Harris T, Coats TJ, Elwan MH. Fluid therapy
in the emergency department: an expert practice review. Emerg Med J. 2018;35(8):511–5. 3.MacDonald N, Pearse RM. Are we close to the ideal intravenous fluid? Br J Anaesth. 2017;119:i63–71.
 COLOIDES
COLOIDES
• MOLÉCULAS DE GRAN PESO
MOLECULAR, INCAPACES DE
ATRAVESAR LA MEMBRANA
• NO INDICADO EN LESIONES
CEREBRALES TRAUMÁTICA

HIDROXIETIL ALMIDÓN
• AMILOPECTINA DERIVADA DE MAÍZ,
PAPA O SORGO
• PRURITO, CUAGULOPATIAS, TERAPIA
DE SUSTITUCIÓN, RIESGO DE MURTE

1.Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med. 2013;369(13):1243–51. 2.Casey JD, Brown RM, Semler MW. Resuscitation fluids. Curr Opin Crit Care. 2018;24(6):512–8.
ALBUMINA vs CRISTALOIDES

ALMIDONES AUMENTARN
RIESGO LRA

NaCl 0.09% MAS USADO PERO

MAS REALCIONADO A ACIDOSIS
HIPERCLOREMICA

SOLUCIONES BALANCEADAS
RIESGO DE HIPERKALEMIA

SPLIT vs SAMRT CRISTALOIDES

vs BALANCEADAS

1. Ostermann M, Liu K, Kashani K. Fluid management in acute kidney injury. Chest. 2019;156(3):594–603.
1. Chawla LS, Davison DL, Brasha-Mitchell E, Koyner JL, Arthur JM, Shaw AD, et al. Development and standardization of a furosemide stress test to predict the severity of acute
kidney injury. Crit Care. 2013;17(5):R207.
3. Farrar A. Acute kidney injury. Nurs Clin North Am. 2018;53(4):499–510.8 Zhao G-J, Xu C, Ying J-C, Lü W-B, Hong G-L, Li M-F, et al. Association between furosemide administration and outcomes
in critically ill patients with acute kidney injury. Crit Care. 2020;24(1):75.