acute kidney injury 3 Flashcards
what is caused by direct damage to the kidney?
intrinsic renal failure
what are the 4 categories of intrinsic renal failure
hint: based on primary site of damage
- tubules
- vessels
- interstitium
- glomerulus
what is the most common catergory of intrinsic renal failure?
acute tubular necrosis (ATN)
what are two major causes of acute tubular necrosis?
ischemia and toxins
what is the etiology of ATF?
- tubular cells die
- slough into the tubular lumen forming casts
- tubular pressure increases
what are the 3 most common IRF categories in order?
- ATN
- interstitial nephritis
- acute glomerular nephritis
hypoperfusion overtime often leads to what?
ischemia
acute tubular necrosis leads to what 3 things?
- loss of urine concentrating ability
- defective distal sodium reabsorption
- reduced GFR
what are the phases seen in the clinical course for acute tubular necrosis
oliguric phase
diuretic phase
recovery phase
what are the two endogenous causes of ATN?
- myoglobin
2. hemoglobin
what are the exogenous causes of ATN?
- cisplatin
- aminoglycosides
- radiocontrast media
- cyclosporine
- heavy metals
- amphotericin B
- foscarnet
rhabdomyolysis from trauma or statins can cause what problem in kidney
ATN due to myoglobin in blood
what is the most common cause for allergic interstitial nephritis
antibiotics
allergic interstitial nephritis can be caused by what things other than drugs
- autoimmune diseases (lupus)
- infiltrative diseases (sarcoidosis)
- infections
what is the MOA of allergic interstitial nephritis
allergic hypersensitivity response.
usually cell mediated, predominantly by T-lymphocyte infiltrate
acute GN is typically treated by what
immunosuppressants or plasmapheresis
what is the typical cause of postrenal failure
obstruction of urine flow
what are 4 causes of obstruction of urine flow
- bladder outlet obstruction
- urethral obstruction
- crystal deposition
- drugs
what drugs commonly obstruct urine flow
- acyclovir
- sulfonamides (Bactrim)
- methotrexate
- indinavir
- vancomycin
what are the most common causes of postrenal failure (nonpharm causes)?
- benign prostatic hyperplasia (BPH)
2. malignancy
what counseling must be given with Bactrim related to kidney disease?
drink lots of water
what are 3 treatment plans for postrenal failure?
- d/c drugs (if possible; antibiotics may be necessary)
- relieve obstruction (with foley catheter)
- immunologic therapy for GN (corticosteroids)
at what level of SCr above baseline should ACEI’s and ARB’s be stopped
more than 30% above baseline
what patients should not receive an ACEI or ARB with AKI?
dehydrated prerenal patients
what is treatment for prerenal disease?
- aggressive fluid replacement if dehydrated
2. manage electrolytes (usually K Mg and phosphate)
what patients require caution when giving fluid replacement for prerenal disease
those with CHF or cirrhosis
pt.s who are anuric or oliguric
pt’s without hypovoemia
what should be done with anuric or oliguric patients when treating
fluid restriction
