Acute Kidney Injury Flashcards

1
Q

Definition of AKI

A

-abrupt loss of kidney function that results in the retention of blood urea nitrogen (BUN), creatinine, and metabolic wastes normally excreted by the kidneys.
-Replaces “Acute Renal Insuffiency”

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2
Q

Classifications of AKI & UOP

A

-Anuric: <50 mL urine/24 hours (ex: pts in shock, bilateral urinary tract obstruction, bilateral renal artery obstruction)
-Oliguric <500 mL/24 hours (patients with acute tubular necrosis)
-Nonoliguric >500 mL/24 hours

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3
Q

AKI Physical Examination

A

-ENT: Ulcerations
-Cardiac: Elevated JVP, S3 or S4, pericardial friction rub, peripheral edema
-Respiratory: crackles, pleural effusions, oxygen requirements, pink frothy sputum
-GI: Ascites
-GU: Enlarged prostate, bladder distention, tenderness
-Skin: Poor skin turgor, rash, itch marks

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4
Q

Causes of AKI: Prerenal

A

-Sudden and severe drop in BP (shock), or interruption of blood flow to the kidneys from severe injury or illness
-problem that occurs before perfusion to the kidney, such as decreased perfusion from a lack of blood volume from either bleeding, dehydration, sepsis, hypotension, trauma, heart failure, a problem within the renal artery from a clot or stenosis, dissection
–Drugs: NSAIDs, ACE, ARBS, prograf, cyclosporine, contrast-all change renal perfusion

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5
Q

Intrarenal: Causes of AKI

A

-Direct damage to the kidneys by inflammation, toxins, drugs, infection or reduced blood supply.
-Acute tubular necrosis: Progression of prerenal, kidney may require dialysis, recovery phase may last months, nephrotic exposure (Abx, contrast, chemo, uric acid, tumor lysis syndrome)
–Allergic interstitial nephritis: Medication induced (abx, PPI, NSAIDs)-fever, rash, arthralgia, hematuria
-Acute glomerulonephritis

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6
Q

Causes of AKI: PostRenal

A

-Sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury

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7
Q

Types of Acute Renal Failure

A

-Acute Tubular Necrosis — 45%
-Prerenal — 21%
-Acute on chronic renal failure — 13% (mostly due to ATN and prerenal disease)
-Urinary tract obstruction — 10%
89% Prerenal, ATN, or Obstructive Causes
-Glomerulonephritis or vasculitis — 4 percent
-Acute interstitial nephritis — 2 percent
-Atheroemboli — 1 percent

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8
Q

Acute Glomerulonephritis

A

-Inflammation and damage to glomeruli
-Autoimmune causes (lupus, goodpasture, IgA nephropathy)
-Vasculitis (polyarteritis, Wegner’s)

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