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PHAR 123* > Acute Kidney Disease > Flashcards

Acute Kidney Disease Flashcards

1
Q

Explain the kidney

A

Bean shaped
there are 2
behind the peritoneum
4-5” long; a little bit larger than fist
Location at T12-l3 (FYI)

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2
Q

What is in the medulla?

A

Contains the nephron and the tubules

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3
Q

What do the minor and major calyx do?

A

They send waste to the ureter

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4
Q

What are the main fxns of the kidney?

A

Filter blood/ excrete toxins
Metabolize compds
Secrete hormones (ex. erythropoietin)
Maintain pH (acid-base) and electrolyte balance

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5
Q

Do patients notice their kidney disease?

A

No, usually silent until advanced stage

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6
Q

Why do patients not experience kidney pain? What is the exception?

A

Because there are no pain receptors in the kidney
Exception is kidney stones (the stones scratch the ureter and cause pain)

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7
Q

Explain the process of blood flow in the kidney

A

Renal artery -> arteries start to branch in the pyramid areas -> afferent arteriole -> glomerulus/bowman’s capsule -> efferent arteriole -> peritubular capillaries -> interlobular vein (out)

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8
Q

Explain the flow of blood within the nephron

A

Glomerulus -> Bowman’s capsule -> prox convoluted tubule -> descending loop of Henle -> Loop of Henle -> ascending Loop of Henle -> distal conv. tubule -> collection duct

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9
Q

What is normal GFR?

A

100-120 mL/min filtration into tubules

takes 40-50 minutes for total blood filtration

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10
Q

What types of molecules are filtered? Provide examples

A

Small (<70kDa) are filtered

glucose, nucleic acids, amino acids, electrolytes

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11
Q

How much Na+ is reabsorbed thru the proximal tubule?

A

60-70% of Na+; water also reabsorbed here due to osmotic gradient

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12
Q

How much filtrate is delivered to the loop of Henle?

A

30 mL/min
the loop passes thru the medulla of kidney

H20 is permeable in the descending loop; Na+ is permeable in ascending loop

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13
Q

How much filtrate is delivered to the collecting ducts?

A

5-10 mL/min

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14
Q

What does vasopressin do to the water channels in the distal and collecting duct?

A

Vasopressin = Antidiuretic hormone

Stimulates water reabsorption alone

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15
Q

What does aldosterone do in the distal tubule and collecting duct?

A

Causes Na+ reabsorption and K+ excretion

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16
Q

How much filtrate goes to the distal and collecting tubules?

A

1-2 mL/min

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17
Q

What are some additional fxns of the distal and collecting tubules?

A

Regulate pH
Respond to acidosis by increasing H+ secrete and HCO3- generation

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18
Q

What can be said about the transporters in the renal proximal tubule?

A

The transporters can be uni- or bidirectional

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19
Q

What are thiazides?

A

They are diuretics that act on the NaCl cotransporters
Prevents Na+ reabsorption

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20
Q

What are amilorides?

A

They are potassium-sparing diuretics which can decrease K+ execration at distal tubule

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21
Q

What is the main marker for kidney function? What is the normal value?

A

Creatinine levels
Normal: 0.9-1.3 mg/dL

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22
Q

What is the significance of creatinine?

A

Produced daily by the muscles as part of normal metabolism
Easily unfiltered, so levels don’t rise unless GRF is reduced
Used to estimate GFR

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23
Q

What can be seen as GFR decreases?

A

Less creatine excreted and creatinine levels rise in the blood
production by muscle still continues

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24
Q

What are the four variables for creatinine clearance?

A

Age, ideal body weight (kg), serum creatinine (uM), sex

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25
Q

What is an easy way to estimate IBW?

A

IBW for a 5ft tall person (50kg M; 45kg F)
Add 2.3 kg for every 1” taller than 5’0”

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26
Q

What is MDRD?

A

Modification of Diet in Renal Disease

We can use MDRD equation to estimate GFR

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27
Q

What are the four variables in MDRD?

A

Serum creatinine, Age, Sex, African American

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28
Q

How is MDRD useful in drug therapy?

A

Many drugs require dosage reduction when renal function is less than optimal

If not adjusted, lowered clearance means accumulation of drug

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29
Q

What are some factors that influence whether a drug is renally excreted?

A

Water solubility

Protein-binding

Tubular secretion

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30
Q

How is CKD severity assigned?

A

GFR acts as a function of kidney function.

Normal kidney function: GFR is above 90ml/min

Kidney failure: GFR is below 15 (may require dialysis)

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31
Q

What is proteinuria?

A

Protein(albumin) in the urine due to issues in filtration (glomerular dysfunction)

A common marker of CKD

32
Q

What is acute kidney injury?

A

Rapid deterioration of renal function within a few hours or days

Cause a build-up of waste products in blood

Affect other organs such as the brain, heart, lungs

33
Q

Can drugs cause acute kidney injury (AKI)?

A

Yes, most drugs confer a small chance of AKI (less than 1%)

Patients with CKD are more susceptible to AKI

34
Q

What are some signs and symptoms of AKI?

A

Too little urine

Swelling in legs, ankles, and around the eyes

Fatigue or tiredness

Shortness of breath

Confusion

Seizures or coma

35
Q

What are some causes of AKI?

A

Pre-renal azotemia *reduced glomerular pressure impairing function of tubules)

Intrinsic renal parenchymal disease (direct damage to nephron and vessels)

Post-renal obstruction

36
Q

What are some common causes of community-acquired causes of AKI?

A

Volume depletion

Medication adverse reactions

Obstruction of the urinary tract

37
Q

What are some common causes of hospital-acquired cases of AKI?

A

Sepsis

Major surgical procedures

Critical illness onvolving heart or lung failure

Contrast agents

Medication adverse reactions

38
Q

What is pre-renal azotemia?

A

It is characterized by an increase in urea and creatinine in the blood due to reduced glomerular pressure, but without signs of tubular damage

Usually reversed if addressed before damage occurs

39
Q

What causes AKI?

A

Reduced cardiac output

Hypovolemia

Medications (NSAIDs and RAAS inhibitors)

40
Q

What are some factors that can reduce GFR?

A

Afferent vasoconstriction

Reduced cardiac output

41
Q

How do NSAIDs cause AKI?

A

Reduction of renal blood flow (via vasoconstriction of afferent arterioles)

Direct injury

42
Q

What are some common comorbitities with chronic glomerular injury?

A

Diabetes (glucose toxicity)

Hypertension (Increased fluid pressure)

43
Q

What causes immune-mediated glomerular injury?

A

Antigens and antibodies tend to get caught in the structure of the glomerulus (high blood flow and pressure)

Immune system may react to parts of the glomerular apparatus directly (autoimmunity)

44
Q

What can cause acute tubular necrosis?

A

Nephrotoxic drugs

Ischemia/Reperfusion

Protein Misfolding

Oxidative stress in mitochondria

45
Q

What is rhabdomyolysis?

A

A syndrome resulting from the release of myglobin. Myoglobin can precipitation the renal tubules, halting tubular flow and causing tubular cell necrosis

46
Q

What is interstitial nephritis?

A

It occurs when spaces between tubules become inflamed. The inflammation usually causes damage to tubules but spares the glomeruli.

Inflammation can be caused by hypersensitive reactions to drugs

47
Q

What is ischemia-associated AKI?

A

The kidney medula operates under relative hypoxic conditions, so it is susceptible to pre-renal azotemia, inflammation, atherosclerosis, and other issues that impact blood flow

48
Q

What are kidney stones?

A

Idiopathic hypercalcuria (more than 75% of stones contain calcium)

Stones can also be made from uric acid and is associated with hyperuricemia

49
Q

Can the formation of kidney stones be perceived?

A

No, stone formationin the kidney is painless, thus, renal damage and hematuria can occur in the absence of pain

Pain is felt due to the distension of the ureter, renal pelvis or capsule

50
Q

What are some risk factors associated with kidney stones?

A

Dehydration

Protein intake

High Na+

*High Ca2+ intake actually may not play a big role

51
Q

What are some complications associated with kidney stones?

A

Damage from complete blockage of urine, backup of toxins, and pressure

Infection or abcess

Repeated stones

52
Q

What is the RIFLE criteria in AKD?

A

The acronym describes progressively worsening presentation of kidney dysfunction

Risk of renal dysfunction
Injury to the kidney
Failure of kidney function
Loss of kidney function
End-stage renal disease (ESRD)

53
Q

What are the criteria for Risk from RIFLE?

A

Increase in SCr more than 1.5x baseline
or
25% decrease in GFR

and
Urine output is below 0.5mL/kg/h for 6 hours

54
Q

What are the criteria for Injury from RIFLE?

A

Increase in SCr more than 2x baseline
or
50% decrease in GFR

and
Urine output is below 0.5mL/kg/h for 12 hours

55
Q

What are the criteria for Failure from RIFLE?

A

Increase in SCr more than 3x baseline
or
75% decrease in GFR

and
Urine output is below 0.3mL/kg/h for 24 h

56
Q

What are the criteria for Loss from RIFLE?

A

Persistant AKI = complete loss of renal function in under weeks

57
Q

What are the criteria for ESRD from RIFLE?

A

Complete loss of renal function

58
Q

What are the strengths and limitations of RIFLE?

A

Strengths:
Provided good prognostic accuracy
Strongly correlated with length of hospitalization stay, renal replacement therapy

Limitations:
Hard to know what the patient’s baseline SCr is before disease begins

59
Q

What is the AKIN criteria for AKD?

A

It is a modified RIFLE criteria

60
Q

What is the definition of Stage 1 AKD according to the AKIN criteria?

A

Increase in SCr from 1.5-2x baseline
or
If increase in SCr is greater than 0.3mg/dL in 48 hours

and
Urine output is less than 0.5ml/kg/h x 6h

61
Q

What is the definition of Stage 2 AKD according to the AKIN criteria?

A

Increase in SCr from 2-3x baseline

and
Urine output is less than 0.5ml/kg/h x 12h

62
Q

What is the definition of Stage 3 AKD according to the AKIN criteria?

A

Increase in SCr from 3x baseline
or
If increase in SCr is greater than 4mg/dL in 48 hours

and
Urine output is less than 0.3ml/kg/h x 12h

63
Q

What are some strengths and limitations of the AKIN criteria?

A

Strengths:
Solely based on SCr change, not on GFR change

Limitations:
Does not provide AKI classification if increase of SCr occurs in more than 48h

64
Q

What are some complications associated with AKI?

A

Pulmonary edema
Anemia
Chest pain (pericarditis)
Muscle weakness
Hyperkalemia
Metabolic acidosis
Permanent kidney damage
Death

65
Q

What are some risk factors associated with AKI?

A

Hospitalization
Aging
CV diseases
Hypertension
Diabetes
Kidney and Liver diseases
Certain types of cancer and their treatments

66
Q

How can AKI be prevented?

A

Hard to prevent AKI, but risk can be reduced by making the following changes:
Living a healthy lifestyle
Managing kidney and other chronic conditions
Paying attention to drug labels, especially for the OTCs

67
Q

What are the functions of kidney dialysis?

A

Treatment of kidney failure
Perform the normal function of kidney
Remove toxins, wastes, and extra fluid from the blood

68
Q

What are the types of kidney dialysis?

A

Hemodialysis

Peritoneal dialysis

69
Q

Describe the process of hemodialysis

A

The most common type of dialysis

Blood is removed from body and filtered by a external hemodialyzer

Requires vascular access (AV fistula or AV graft used)

70
Q

What are the advantages and disadvantages of AV fistula?

A

Advantages:
A surgery connects an artery and vein in the arm. This operation reduces clotting and infection during dialysis

Disadvantages:
It can take 3-4 months to mature before dialysis can be started
Avoid in people with weak veins (older adults)

71
Q

What are the advantages and disadvantages of an AV graft?

A

Advantages:
A tube connects an artery to a vein in the arm and allows for faster recovery vs. AV fistula (matures in 2-3 weeks)

DIsadvantages:
Increased chance of clotting and infection
The tube needs to be replaced as it breaks down from being in the body

72
Q

What are advantages and disadvantages of vascular access catheter?

A

Advantages:
Dialysis can be started immediately

Disadvantages:
A catheter needs to be inserted each time because it cannot be left in over a period of days.
After a few catheter insertions, it can damage the veins

73
Q

What is peritoneal dialysis?

A

Like all types of dialysis, it removes wastes and toxins from the blood when kidneys are no longer functional

Dialysis fluid is flowed from. abag into the peritoneal cavity via a catheter into the abdomen

The pertioneum acts as a filter, and the solution absorbs wastes and extra fluid

After a few hours, the solution along with the wastes is drained out

74
Q

What are the two types of peritoneal dialysis?

A

Continous ambulatory peritoneal dialysis

Automated peritoneal dialysis

75
Q

Can diuretics help treat AKI?

A

No clear evidence showing the help of diuretics

76
Q

How are cancer and AKI associated?

A

AKI and cancer are associated with aging and will often develop independently at that age

Cancer drugs are also nephrotoxic

PHAR 123* (11 decks)

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