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Pathophysiology > 28 Acute Kidney Injury and Chronic Kidney Disease > Flashcards

28 Acute Kidney Injury and Chronic Kidney Disease Flashcards

1
Q

Acute Kidney Injury fka…

A

Acute Kidney Failure

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2
Q

Acute Kidney Injury

A

sudden reduction of kidney function

  • causes DECREASED GFR
  • reults in characteristic alterations in laboratory blood + urine tests
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3
Q

Decreased Glomerular Filtration Rate [GFR]

A
  • urine output
  • retention of nitrogenous waste
  • incr serum creatinine
  • disrupt in fluid, electrolyte, + acid=base balance
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4
Q

renal function is monitored by ___

A

calculated by SERUM CREATININE + calculated GFR

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5
Q

retention of AZOTEMIA/UREMIA (metab waste) is monitored by

A

BUN

-produces widespread systemic effects- [UREMIC SYNDROME]

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6
Q

3 sites of disruption

A

1 PRERENAL
2 POSTRENAL
3 INTRINSIC/INTRARENAL

-distinction bw sites of disruption helps determine appropriate therapy

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7
Q

PRERENAL disruption

A

renal perfusion

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8
Q

POSTRENAL disruption

A

urine flow distal to the kidney

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9
Q

INTRINSIC/INTRARENAL disruption

A

circumstances w/in kidney blood vessels, tubules, glomeruli, or interstitium

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10
Q

Prerenal Kidney Injury

A

due to conditions that diminish perfusion of kidney

-prolonged prerenal ARF leads to acute tubular necrosis (intrinsic)

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11
Q

Prerenal Kidney Injury

causes

A
  • hypovolemia, hypotension, HF
  • renal artery obstruction
  • fever, vomit, diarrhea
  • burns
  • overuse of diuretics
  • edema, ascites
  • drugs ACE inhibitors, angiotensin II blockers, NSAIDs
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12
Q

Prerenal Kidney Injury

s/s

A
  • low GFR
  • oliguria
  • high urine specific gravity
  • high osmolarity
  • low urine sodium
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13
Q

prolonged PRERENAL ARF leads to…

A

Acute Tubular Necrosis [ATN]

—-intrinsic

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14
Q

Post Renal Kidney Injury

A

due to OBSTRUCTOIN w/in urinary collecting system DISTAL to the kidney
-clinical findings are based on duration of obstruction

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15
Q

Post Renal Kidney Injury

effects

A
  • elevated prssure in Bowman capsule

- impedes flomerular filtration

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16
Q

Intrinsic/Intrarenal Kidney Injury

A

due to DYSFUNCTION OF THE NEPHRONS + kidney itself

  • most common problem w/in renal tubules
  • —-results in [ATN]
  • —-may also occur w glomerular, vascular, or interstitial etiologies
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17
Q

Acute Tubular Necrosis [ATN]

causes

A

1 nephrotoxic insult (contrast media)

2 ischemic insult (sepsis)

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18
Q

Intrinsic/Intrarenal Kidney Injury

2 pathophysiological processes

A

1 Vascular process

2 Tubular process

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19
Q

Vascular pathophysiological processes

A

DECREASE in renal blood flow
-hypoxia, vasoconstriction

1 of 2 intrinsic/intrarenal kidney injury

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20
Q

Tubular pathophysiological processes

A

INFLAMMATION + reperfusion injury
-casts, obstructs urine flow, tubular backleak

1 of 2 intrinsic/intrarenal kidney injury

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21
Q

Intrinsic/Intrarenal Kidney Injury

self-limiting

A

can repair itself (self-limiting)

or if injury is sustained, leads to end-stage renal disease

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22
Q

Acute Tubular Necrosis [ATN]

3 phases

A

1 Prodromal
2 Oliguric
3 Post-Oliguric

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23
Q

Acute Tubular Necrosis [ATN]

clinical presentations

A

varies by each phase (3)

-lab findings can help differentiate prerenal from intrinsic/intrarenal kidney injury

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24
Q

Prodromal Phase of ATN

A
  • injury has occured
  • normal or decr UO
  • incr BUN + Cr

-usually asymptomatic bc normal UO + normal GFR

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25
Q

Oliguric Phase of ATN

A
  • oliguria/anuria
  • Vol overload
  • hyPERkalemia>metab acidosis
  • azotemia/uremia
  • hypervolemia>edema
  • uremic syndrome
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26
Q

Post-Oliguric Phase of ATN

A
  • fluid vol deficit

- labs begin to normalize

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27
Q

Renal Function Recovery

A
  • incr DIURESIS
  • tubular function impaired (GFR + urine quality)
  • azotemia continues
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28
Q

diuresis

A

amount of urine produced in a given time

29
Q

oliguria

A

DECREASED diuresis/UO

30
Q

anuria

A

NON-urination

31
Q

azotemia

A
  • Waste products remain in the blood
  • Little or no urine is produced, although the kidney itself is working
  • When nitrogenous wastes, such as creatinine and urea, build up in the body, the condition is known as azotemia
32
Q

uremia

A

disorder of kidney function that occurs when the kidneys can not properly remove urea from the body
-urine waste accumulate in the blood and can be another set of diseases.

33
Q

normal urine output

A

800-2,000 ml/day

34
Q

oliguric urine output

A

<400 ml/day

usually 50-400ml

35
Q

anuria urine output

A

<100 ml/day

36
Q

uremic syndrome

A

fatigue, nausea, loss of appetite, a metallic taste in the mouth and mental confusion

37
Q

Chronic Kidney Disease [CKD]

A
  • outcome of progressive + IRREVOCABLE LOSS OF FUNCTIONAL NEPHRONS
  • DECREASED kidney function or damage of 3 months
  • GFR<60ml/minute/1,73cm for 3 months
38
Q

Chronic Kidney Disease [CKD]

progressive process

A

1 Chronic Kidney Disease [CKD]
2 Chronic Renal Failure [CRF]
3 End-Stage Renal Disease [ESRD]

ESRD requires dialysis

39
Q

how many functional nephrons are lost to be CKD?

A

more than 75% of nephrons lost

40
Q

Chronic Kidney Disease [CKD]

diagnosis

A
  • blood test
  • urinalysis
  • imaging studies
41
Q

CKD is a global health problem that is often linked w…

A

linked w hypertension, diabetes mellitus + other comorbidities

42
Q

what is GFR rate in CKD?

A

GFR<60ml/minute/1,73cm for 3 months

43
Q

Chronic Kidney Disease [CKD]

risk factors

A 
1 diabetes
2 hypertension
3 recurrent pyelonephritis
4 glomerulonephritis
5 polycystic kidney disease
6 fam hx of CKD
7 hc of exposure to toxins
8 >65 yrs old
9 ethnicity
44
Q

kidneys compensate for CKD until…

A

75-80% of nephrons are damaged/nonfunctional

45
Q

progression of CKD is ____ + ____

A

progressive + irreversible

46
Q

Chronic Kidney Disease [CKD]

staging

A
  • progression monitored by staging systm
  • —based on incr severity
  • 5 stages of progression
  • –each higher stage has further declining GFR + kidney function
47
Q

<75% nephron loss

A

Stage: DECREASED RENAL RESERVE

  • no s/s,
  • normal BUN + creatinine
48
Q

75-90% nephron loss

A

Stage: RENAL INSUFFICIENCY

  • polyuria, nocturia
  • slight elevation in BUN + creatine
  • may be controlled by diet + medication
49
Q

<90% nephron loss

A

Stage: ESDR

  • azotemia/uremia
  • fluid/electrolyte abnormalities
  • osteodystrophy
  • anemia
  • dialysis or transplant is critical
50
Q

Stage 1 CKD

A

kidney damage w norm or incr GFR

GFR >90 mL/min/1.73cm

51
Q

Stage 2 CKD

A

mildly decr GFR

GFR 60-89 mL/min/1.73cm

52
Q

Stage 3 CKD

A

moderately decr GFR

GFR 30-59 mL/min/1.73cm

53
Q

Stage 4 CKD

A

severely decr GFR

GFR 15-29 mL/min/1.73cm

54
Q

Stage 5 CKD

A

ESRD

GFR <15 mL/min/1.73cm

55
Q

Chronic Kidney Disease [CKD]

complications

A 
1 hypertension + cardiovascular disease
2 uremic syndrome
3 metab acidosis
4 electrolyte imbalance
5 bone + mineral disorder
6 malnutrition
7 anemia
8 pain
9 depression
56
Q

hypertension + cardiovascular disease in CKD

A

-hypervolemia, escalated atherosclerotic process, heightened RAAS + SNS activity

57
Q

uremic syndrome in CKD

A

retention of metabolic wastes

  • impaired healing
  • pruritus
  • dermatitis
  • uremic frost
58
Q

metabolic acidosis of CKD

A

retention of acidic waste products

  • hyperkalemia
  • kidneys lose ability to secrete H+ ions + bicarbonate
59
Q

electrolyte imbalance of CKD

A

retained K, phosphorous, Magnesium

60
Q

electrolyte imbalance of CKD

mgmt

A
  • fluid restriction if Na <135mmol/L
  • if edema/HF/hypertension, may need 2g/day Na
  • mild hyperkalemia (<6mmol/L): reduce K intake, correct merab acidosis
  • K level >6mmol/L: IV Ca gluconate, D5W, + insulin; oral/rectal Na polystyrene sulfonate
  • protein restriction
61
Q

Bone + Mineral Disorders of CKD

A
  • elevated phosphorous + PTH causes altered bone/mineral metabolism
  • kidneys unable to produce active vit D(1,25-ch-vITC)
  • —-prevents reabsorption of Ca in sm. intestines
62
Q

Bone + Mineral Disorders of CKD

mgmt

A
  • PTH, Ca, phosphorous should be monitored if GFR <60mL/min/1.73cm
  • hypocalcemia: Ca carbonate, Ca acetate, lanthanum carbonate
  • Vit D for deficiency + suppress PTH
  • calcimimetics suppress PTH
63
Q

Anemia of CKD

A

lack of erythropoietin

  • uremia shortens RBC life
  • Cardiorenal Anemia Syndrome
64
Q

Cardiorenal Anemia Syndrome

A

combo of worsening CKD, anemia, + HF

65
Q

Dialysis

A

used for ATN + CKD stage 5

—removed metab wastes + correct fluid electrolyte abnormalities

66
Q

types of Dialysis

A

1 hemodialysis

2 peritoneal dialysis

67
Q

what should be monitored if GFR<60ml?

A

PTH, Ca, phosphorous

68
Q

protein restriction is for _____

A

fluid electrolyte imbalances

69
Q

CKD is based on…

A

% nephons lost or GFR (5 stages)

Pathophysiology (32 decks)

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