AKI and CKD Flashcards by Brandy Wilson

What is normal creatinine value?

0.6——1.2 mg/dL

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What is azotemia?

accumulation of urea and creatinine in blood (nitrogen wastes)

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What are three broad causes of AKI?
What are differences?

Prerenal-circulation
Intrarenal-inside kidney
Postrenal-obstruction after kidneys

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What is the main cause of death in AKI?

Infection
–Careful aseptic technique-

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What is acute tubular necrosis?
(ATN)

Most common intrarenal cause of AKI in hospitalized pts
It is from ischemia, nephrotoxins, sepsis.

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What cause of AKI causes hydronephrosis?

Postrenal
Mechanical obstruction causes reflux

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What electrolyte will be altered in AKI?

Potassium
–Usually hyper–

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What are stages of AKI?

R-Risk
I-Injury
F-Failure
L-Loss
E-End stage renal disease
–In each of these progressive stages, GFR decreases and urine output decreases and creatinine increases–

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Why is creatinine not BUN the best indicator of kidney function?
—Dont say Bun but B-U-N–

Rise of BUN can also be from dehydration, infection, corticosteroids, fever, injury, GI bleeding.
Creatinine is not affected by other factors.

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What are the common manifestations of AKI in oliguric phase? (first phase)

Oliguria (less than 400 ml/daily)-Specific gravity around same as plasma (1.010) –This shows no concentrating ability–
Metabolic Acidosis (Kussmaul resp)
Fluid unbalance (usually hypervolemia but can be hypo)
Hyponatremia»cerebral edema
Hyperkalemia
Leukocytosis (high WBCs)
Elevated creatinine and BUN
Neuro changes (like fatigue, difficulty concentrating, seizures)
Lasts 10-14 days

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What are the 3 phases of AKI?

Oliguric
Diuretic
Recovery

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What are common manifestations in diuretic phase of AKI?

Lots of low concentrated urine output
Loss of electrolytes and fluid volume
Lasts 1-3 weeks

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What is the recovery phase of AKI?

GFR increases
May take up to a year (depending on severity)

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What are some common diagnostic studies in AKI?

History (to find cause)
Creatinine and BUN and CMP
UA
Kidney Ultrasound-preferred
Renal Scan-careful with contrast
CT Scan–careful with contrast

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What is caution with metformin and contrast agents?

Metformin must be held 48 hours before and after contrast given

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Goals for AKI care.

Find cause and correct
Manage s/sx
Prevent complications while kidneys recover

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What is general rule for figuring fluid restriction?

Take all loss for full 24 hours
Add 600 ml to that number
That should be the the amount they are allowed for next day.

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What are common therapies for hyperkalemia?

Insulin-to move K+ into cells
Sodium Bicarb -to move K+ into cells
Calcium Gluconate (combats any cardiac dysrhythmias)
Kayexalate (sodium polystyrene sulfonate)
Hemodialysis

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Contraindication for Kayexalate.

Paralytic ileum

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What are types of Renal replacement therapy? (RRT)

Peritoneal dialysis
Hemodialysis
Continuous renal replacement therapy

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What is a renal diet?

Carbs and Fats
Limit protein
Restrict sodium

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What are important nursing assessment pieces in AKI?

V/S
Strict I/O
Daily weights
Examine urine
Assess gen appearance
Assess mentation
Oral mucosa
Skin health (itchy so skin damaged)
Lung sounds
Heart rhythm
Labs
Diagnostics
Mouth care (stomatitis common)

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What is contrast induced nephropathy?

CIN
Contrast media causes nephrotoxic injury
Ensure adequate fluid intake
Hold metformin
Use ultrasound instead

What are risk factors for CKD (chronic kidney disease)?

> 60 yo
CV disease
DM
HTN
Fam Hx
Ethnic minority

What is considered ESRD? (end stage renal disease)

GFR <15 ml/min

What is pathos of metabolic acidosis in CKD?

Kidneys can't get rid of ammonia (acid) Kidneys cant produce bicarb (base)

Why is anemia a problem in CKD?

Erythropoietin can't be made by kidneys Folic acid lost in dialysis

What is the most common cause of death in AKI?

Infection

What are casts in UA?

Sloughed off epithelial cells from renal tubules. These have become necrotic and indicate tubular damage and loss of concentrating ability. Pts will usually have specific gravity of 1.010 (same as plasma)

In renal disease, what should we keep in mind about infection?

Many will NOT run fever. ABx are excreted in kidneys so can build up toxicity quickly. Many ABx are damaging to kidneys, so caution needed.

What is definition of CKD?

Decreased GFR of <60ml/min for longer than 3 months.

What is definition of ESRD?

GFR <15 ml/min Dialysis is necessary to sustain life

What is uremia?

High levels of urea in blood. Kidney function is so declined it is damaging other body systems This is usually in ESRD

What is the effect of CKD on glucose metabolism?

Increases glucose levels and increases insulin levels. This is because kidneys are not filtering out these products.

What changes to insulin/glucose levels usually happen after starting dialysis?

Decrease need for insulin. Blood glucose levels usually improve.

What are effects of CKD on triglycerides?

Increase

What are effects of CKD on hematology?

Anemia Impaired platelets Increased risk of infection

What are CV effects of CKD?

HTN CVD (from calcium deposits) Left ventricular hypertrophy PAD

What are effects of CKD on respiratory system?

Edema in lungs Pneumonia Pleuritis Met acidosis=Kussmauls

What are neuro effects of CKD?

CNS depression as wastes build Paresthesias in legs/feet Foot drop Weakness/atrophy Restless legs Decreased DTRs Headache from cerebral edema

What is CKD-MBD?

CKD mineral bone disorder Kidneys decrease, Vitamin D can't be absorbed into GI tract, Calcium can't be absorbed either so serum levels decrease. This causes parathyroid to to kick up causing bones to lose calcium. Osteomalacia happens and calcium in blood increases resulting in CV disease and arteriosclerosis. At same time, decrease in kidney function causes an increase in serum phosphate.

What is first sign of kidney disease?

Persistent proteinuria in UA

What is cause of death in most dialysis patients?

CV disease

Why would mag be given extremely cautiously (if not at all) to a CKD patient?

Mag is excreted in kidneys. Can become lethal quickly

What is a normal range of hemoglobin in men? Women?

Men=14---18 Women=12---16

What is dietary adjustment made for patients on peritoneal dialysis (PD)?

Increase in dietary protein

What dietary precautions are needed for CKD patients?

Na+ and K+ and phospate restrictions

What are three cycles of PD?

Inflow (fill about 10 min) Dwell (4-6 hours) Drain (15-30 min)

What is advantage of CRRT (continuous renal replacement therapy)?

Not as aggressive. Functions more like a natural kidney Does not drop BP or have rapid shifts in fluid Easier on patients

What are success rates of kidney transplants?

90-95%

What are contraindications of kidney transplant?

Cancer Untreated anything or noncompliance Respiratory failure --Not HIV--

What is the major cause of mortality in a transplant patient?

Infection --These patients will be on immunosuppressant drugs, dealing with the effects of ESRD, gone through a major surgery-- Usually happens within one month post-op

What are s/sx of organ rejection?

Pain Flu like edema oliguria

What is a common cause of urinary obstruction in a post transplant patient?

Blood clot in catheter. Keep catheter flowing and flushed

Which dialysis types require fluid restrictions?

Hemodialysis does Peritoneal does not