Acute and Chronic Kidney Disease Flashcards
AKI/Acute Renal Failure
a sudden reduction in kidney function, as measured by glomerular filtration rate (GFR).
REVERSIBLE
AKI: pre-renal
Pre-renal includes any reduced blood flow to the kidney due to things like: circulatory volume depletion, volume shifts (third-spacing), decreased CO and PVR, vascular obstruction.
AKI: Intra-renal
Renal includes acute tubular necrosis, which can result from several different causes. Prolonged renal ischemia, sepsis, and nephrotoxins being the most common ones. It is worthwhile mentioning that pre-renal injury can convert into a renal injury if the exposure to the offending factor is prolonged enough to cause cellular damage.
Also causes include: parenchymal changes caused by disease or nephrotoxins, acute tubular necrosis, glomerulonephritis, etc.
AKI: post-renal
Post-renal mainly includes obstructive causes, which lead to congestion of the filtration system and thus eventually lead to shutting down the kidneys. The most common ones being renal/ureteral calculi, tumors, or any urethral obstruction.
examples: BPH, tumor, calculi, surgical accident, spinal cord injury (neurogenic bladder–retention)
**bladder outlet obstruction common cause of post renal AKI
AKI: Oliguric Phase
UO <4000 ml/day
occurs 1-7 days of injury
UA: casts, rbc’s, wbc’s, protien
decreased urine output leads to fluid retention
can lead to metabolic acidosis as the body cannot excrete hydrogen through the urine
closely monitor fluid intake here
AKI: Diuretic Phase
lasts 1-3 weeks
daily Urine output of 1-3 liters, up to 5 liters
osmotic diuresis from high urea
low specific gravity, nearly iso-osmolar
AKI: Recovery Phase
begins when GFR increases and allows BUN and Cr to plateau and then decrease.
major improvements are seen within 1-2 weeks
AKI: Dx
thorough hx, serum BUN and Cr, serum electrolytes, UA, renal ultrasound, CT scan, biopsy
AKI: Tx
goals: eliminate cause, manage sx/sx, prevent complications
loop diuretics (furosemide)
osmotic diuretics (mannitol)
outcomes: maintain normal fluid and electrolyte balance, adhere to Tx regimen, no complications, complete recovery
CKD
progressive, IRReversible loss of kidney function
GFR less than 60 ml/min or 1.73 m2 for longer than 3 months
can be asymptomatic
CKD: Dx
h & p
protienuria
albumin to cr ratio
CKD: Na+ and Mg2+
hyPOnatremia (dilutional): confusion, seizures, coma, fluid restriction
hyPERmagnesia:
NO GIVING MILK OF MAG
antacids with magnesium, dark leafy greens, etc.
CKD: Ca2+ and Phosphorous
hyPOcalcemia: decreased intestinal Ca2+ absorption
increased parathyroid hormone leads to hyPERphosphatemia
CKD: Hematologic changes
decreased production of EPO, iron stores, folic acid synthesis.
bleeding risk
CKD: GI and CNS
GI: constipation
CNS: CNS depression
