IBCC Episode 18 - Acute Kidney Injury

In this episode of The Internet Book of Critical Care Podcast, Josh and Adam Thomas discuss acute kidney injury (AKI) and oliguria, focusing on definitions, significance, and management in the ICU setting. They review the arbitrary nature of AKI definitions based on creatinine and urine output, emphasizing that while these cutoffs help identify AKI, they aren't definitive. The hosts highlight the importance of recognizing different AKI phenotypes, such as isolated oliguria and non-oliguric renal failure, which require different management approaches. They also discuss common causes of AKI (pre-renal, intrinsic, and post-renal), nephrotoxic medications, and relevant tests, while advising against relying on urine eosinophils and fractional excretion of sodium (FENA). The speakers advocate for a thoughtful approach to fluid administration, considering the patient's volume status and potential for intrinsic renal failure, and suggest vasopressor challenges or furosemide stress tests to assess renal function. They also touch on the importance of reviewing medication lists, adjusting dosages, and managing potassium levels, as well as indications for dialysis and the use of phosphate binders.