88 89 Acute Kidney Injury and rhabdo Flashcards
What are the most common causes of community acquired a KI?
Volume depletion, medications, infection, urinary obstruction
Explain why sometimes progressive a KI occurs after initial recovery from a KI
Because if the number of nephrons drop a lot of critical number, continued hyperfiltration results and progressive glomerulosclerosis eventually Leading to nephron loss. A vicious cycle of nephron loss then and Sue’s until complete a KI occurs.
List the major causes of intrinsic AKI
ATN from pre-renal, crystal induced nephropathy, rhabdo my lysis, Goodpasture’s syndrome or Wagner’s granulomatosis, acute interstitial nephritis, acute glomerulonephritis
What is the pathognomonic Clinical presentation of urinary obstruction?
Alternating oliguria and polyuria
Name to a KIN stages by GFR decrease?
Stage one is a decrease of 25 to 50%, stage two is a GFR decrease of 50 to 75% stage III is GFR decrease of greater than 75% after that is an stage renal disease
List of major diagnostic test for the work up of a cute kidney injury?
CBC, chemistry including magnesium and phosphorus, liver function test, blood cultures. UA, urine osmolality, urine sodium, urea levels, EKG, bedside ultrasound for urinary bladder volume and inferior vena cava
Define contrast induced nephropathy.
A relatively small change in stream creatinine of 25% increase from baseline 48 to 72 hours in fusion
Why Have ER doctor to become Cavalier about contrast induced nephropathy?
Because after using propensity scoring matching to reevaluate the studies they fail to find a statistically higher incidence of a KIA and no differences in mortality, development of chronic kidney disease, or need for dialysis or transplant Tatian in the future.
List the major causes of Crystal induce nephropathy?
Tumor lysis syndrome in the setting of elevated uric acid, medications in particular acyclovir, sulfonamides, Indinacir, triamterene
What, antihypertensive medication is a common cause of community acquired a KI?
Hason have it is because they preferentially dilate the E Farrant artery causing a 10 to 20% increase and see him creatinine
In what condition can ace in Hibbett her’s precipitate a serious AKI?
Bilateral renal artery stenosis
Name the three major causes of prerenal acute kidney injury
Hypovolemia, hypotension, renal artery and small vessel effects : Medications, hypercalcemia, embolus, thrombosis, dissection, micro vascular thrombosis
Described The nephrotic syndrome?
Edema, protein urea, hypoalbuminemia, hyperlipidemia, hypercoagulability from loss of anti-thrombin three
Describe the nephritic syndrome?
He met your Reared blood cell cast, decreased urine output, and hypertension
And patient with no renal function, how fast is your creatinine increase?
1 to 3 mg/dL a day And if it is less, that indicates residual renal function
What does it mean if a patient has zero GFR but creatinine increase is less than one per day? Three per day?
If it’s less than one and that indicates residual renal function, if it’s faster that indicates rhabdo my lysis
How long does it normally take for CM creatinine level to elevate?
And healthy people, it may take 48 hours and you may have to lose more than half of the functioning nephrons before creatinine elevated to an abnormal level
BUN to creatinine ratio and pre-renal versus intrinsic renal injury?
Greater than 20 and pre-renal less than 20 and intrinsic
Fractional excretion of sodium and intrinsic versus pre-renal injury?
Fractional excretion of sodium is greater than 1% due to an inability to dilute urine. If you have this problem and you’re not getting enough fluid to the kidneys in the first place, this suggests Pre-renal injury with the fractional excretion of sodium of lesson 1%
What does it tell you if you have hemoglobin and urine dipstick but no red blood cells on microscopy?
Myoglobinuria
What is the imaging test of choice for urologic imaging in the setting of a KI?
Reno ultrasound approximately 90% sensitivity and specificity for Hydro nephrosis due to mechanical obstruction
At what kidney size do you suspect chronic kidney disease?
Less than 9 cm suggest chronic kidney disease.
What ultrasound finding other than size and the kids to fuse parenchymal disease in the kidney?
Hyperechogenicity
Preferred fluid for kidney injury?
There has been a small advantage shown for LR, have her look out for hyperkalemia
What do you far level should you avoid IV contrast studies?
Yeah definitely try to avoid when GFR isless than 30
How do you prepare patients for contrast studies if they have abnormal kidney function?
Pre-hydrate them with 500 to 1000 mL of LR a normal Celine
How long does it take for complete obstruction to cause permanent loss of renal function?
About 10 to 14 days in the setting of complete. Also worse if UTI present
What is a furosemide stress test?
It can be used in the setting of mild AKA to determine diuretic responsiveness as well as to predict worsening renal function. Administer 1 mg per kilogram of Lasix and patient I haven’t had it before or 1.5 mg per kilogram’s in those with prior exposure. Are you an apple of less than 200 mL over to ours has a sensitivity to 87% and specificity of 84% to predict progression to stage 3AKI
Can I roast be used in the setting of a KI?
Although they don’t have the a.k.a. itself, worm fluid overload his present you can use it in the setting of mild to moderate AKI
Alternative Lasixfor fluid overload patients With acute kidney injury?
Dialysis
At what pH level would you consider dialysis in the setting of and urea or fluid overload?
PH of less than or equal to 7.1
When should you use dialysis?
Acidosis of less than 7.1, electrolyte disorders intoxicants, fluid overload, uremia
What is an important consideration for diabetics with IV contrast?
They are taking met Forman, there is an increased risk for Met Forman associated lactic acidosis especially in patients with a GFR between 30 and 60.
How to manage patients with renal disease taking met Forman that require IV contrast
For patients with a GFR of less than 30, Met Forman should be withheld at the time of contrast in fusion and 448 hrs. after the procedure renal function to be reassessed 48 hours
What is the most common cause of rhabdomyolysis
Alcohol and drugs of abuse. Also medications and muscle disease is trauma and MS seizures and mobility, infection, strenuous physical activity and heat related illness
Why is alcohol a risk factor for rhabdo my lysis
In addition to, induced muscle and immobility, it has a direct toxic affect to the muscle.
Which cars of rhabdo is least likely to cause acute kidney injury?
Strenuous activity and athletes military recruits for marathon runners
Name the major clinical features of rhabdo my lysis?
Muscle pain, weakness, malaise, fever, dark brown urine. And severe rhabdo, nausea, vomiting, abdominal pain, tachycardia
At what level of Serum creatinine kinase can you really diagnose rhabdo my lysis?
At about five times or greater increase above the upper threshold so around 5000
Describe the timeline of onset and resolution of elevation and creatine kinase for rhabdo
The level begins to rise approximately 2 to 12 hours after injury, peace within 24 to 72 and then the clients relatively constant of 39% of the previous days value
What is the sensitivity and specificity of myoglobinuria and diagnosing rhabdo my lysis?
Quite low because the levels of myoglobin return to baseline quickly so it does not rule in or out the diagnosis
Laughs order to evaluate for rhabdo?
UA, electrolytes to value it for hypercalcemia, hyper kalemia hyper you’re a senior, hyperphosphatemia. Obtain EKG. CM creatinine and BUN levels. Obtain a baseline CBC and PT, PTT, February GEN level, federal split products to evaluate for DIC
Treatment of rhabdo For crush injury in the prehospital setting?
Early and vigorous IV fluid resuscitation to prevent kidney injury. Once a limb is extricated, IV normal Celine should be initiated at 1 L per hour.
What should be the initial fluid of choice in rhabdo resuscitation
Use normal sailing to make sure you’re not exacerbating hyperkalemia by using lactated ringer’s
Emergency treatment of rhabdo?
IV rehydration for the next 24 to 72 hours. Rapid infusion of 4 mL per kilogram per hour with the goal of maintaining your an output of 3 to 4 mL per kilogram per hour. Or 200 to 300 mL of urine per hour
What things have been found in effective for rhabdo?
Mannitol infusion, loop diuretics, bicarb, differing fluid choices
Disease complications of rhabdo?
Acute kidney injury, Acid-based arrangements, electrolyte disturbances, DIC, mechanical complication such as compartment syndrome.
What is the McMahon score
It’s a score used to determine the need for aggressive resuscitation or dialysis when faced with a patient who is at risk for complications of resuscitation such as a patient with heart failure.
A.k.a. who is at risk for dying or permanent real injury from rhabdo
Dispo for patients with rhabdo?
The majority of healthy patients that present with exertional rhabdo and without court comorbidities can we do the PO and IV hydration, observed in ED and then released. Anyone else should be admitted for IV hydration
