Acute Kidney Injury Flashcards
Acute kidney injury
Ischemic injury- volume depletion and decreased perfusion
Toxic from chemicals
Sepsis
Injury initiates inflammation and vascular response- cell death
CAUSE of Prerenal AKI
Inadequate perfusion
Hypotension, hypovolemia, sepsis, inadequate CO, renal vasoconstriction, renal artery stenosis
Decreased GFR - low glomerular filtration pressure
Failure to restore blood volume, BP, O2 delivery - causes ischemic cell injury and necrosis to tissues
Cause IntraRenal AKI
Acute tubular necrosis
Prerenal AKI, nephrotoxic agents, acute glomeruloneophritis, vascular disease
Prerenal-> IntraRenal
- hypotension, hypovolemia-> ischemia, inflammatory response
Nephrotoxic agents
Antibiotics (aminoglycosides), heavy metals, contrast dye, rhabdomyolysis (increased myoglobin), drug overdoses, crush injuries
Post Renal AKI
Rare condition
Usually occurs with urinary tract obstruction
Causes of post renal AKI
Bladder outlet obstruction
Prostatic hyperplasia
Bilateral utereal obstruction
Tumor
Neurogenic bladder
Is AKI a slow or fast onset?
Sudden decline, rapid progression (within hours)
AKI characteristics
Decreased GFR, urine output
Increased BUN, Cr
May be reversible
What does Cr measure in the body?
How well the kidneys filter out waste
S/sx AKI
Oliguria <400mL/24 hrs
Begins 1 day after hypotensive event/assault to kidneys
Lasts 1-3 weeks
Pharm treatment
Goal: stabilize patient until kidney function is restored
To correct fluid/electrolyte imbalances
Furosemide to remove K+
Dextrose and insulin - move K+ back into cells
Binders- sodium polystyrene sulfonate, patiromer, sodium zirconium cyclosilicate
To correct acid base imbalance
Metabolic acidosis
Sodium bicarb
Other ways to treat AKI
Manage BP
Avoid nephrotoxic drugs
