Acute kidney injury

Question 1

Patho of acute kidney injury

Answer 1

ischemic injury - related to volume depletion and decreased perfusion
toxic injury from chemicals - sepsis

injury initiates an inflammatory response, vascular response, and cell death

Question 2

what are the 3 classifications of AKI

Answer 2

prerenal
intrarenal
postrenal

Question 3

what is prerenal

Answer 3

most common cause is inadequate perfusion
-hypotension, hypovolemia, sepsis, inadequate cardiac output, renal vasoconstriction, renal artery stenosis

decreased GFR due to low glomerular filtration pressure
failure to restore blood volume, blood pressure, and oxygen delivery can cause ischemic cell injury and necrosis

Question 4

intrarenal AKI

Answer 4

continuation of prerenal due to hypotension, hypovolemia causing ischemia and inflammatory response of kidney

most common cause is acute tubular necrosis (ATN)

Question 5

nephrotoxic ATN causes

Answer 5

antibiotics
heavy metals
constrast dye
rhabdomyolysis

Question 6

postrenal AKI

Answer 6

rare condition that usually occurs with urinary tract obstruction that affects both kidneys
can see it bc of - bladder outlet obstruction, prostatic hyperplasia, bilateral ureteral obstruction, tumor, neurogenic bladder

Question 7

what will lab values look like in acute kidney injury

Answer 7

sudden decline in function and rapidly progressive

decreased GFR, decreased UOP, increased BUN, elevated Cr

can be reversible

Question 8

clinical manifestations of AKI

Answer 8

oliguria <400mL/day
begins 1 day after hypotensive event and lasts 1-3 weeks

Question 9

what is management of acute kidney injury

Answer 9

goal of treatment is to stabilize patient until kidney function is returned:
correct fluid and electrolyte imbalances
-lasix to try to push kidneys to function and remove potassium, dextrose and insulin
correct acid-base imbalance (metabolic acidosis) = sodium bicarbonate
manage BP