Acute Kidney Injury

Question 1

Prostaglandin vasodilation

Answer 1

Prostaglandin causes renal vasodilation it is also a pain mediatiator be careful with NSAIDs because they prevent prostaglandin

Question 2

Glomerulus

Answer 2

Non selective filtration dumps everything except the big molecules red blood cells and protein

Question 3

Re absorption and secretion

Answer 3

Potassium chloride and sodium are re absorbed into tubular capillaries from the proximal tubules loop of he le and distal tubule

Question 4

Geriatric considerations

Answer 4

Structural kidney changes loss if renal mass and nephrons=greater risk of kidney injury but are not automatically functional loss

Question 5

Prerenal

Answer 5

External factors that reduce kidney blood flow ex-hypovolemia fluid shifts sepsis heart failure liver failure anaphylaxis blood clots stiffening of renal artery

Question 6

Intrarenal

Answer 6

Direct damage to kidney tissue causing impaired function of the nephron ex glomerulonephritis interstitial nephritis acute tubular nephritis contrast induced nephropathy

Question 7

Post renal

Answer 7

Mechanical obstruction of urine outflow ex bph bilateral ureter obstruction foley blockage

Question 8

Acute tubular necrosis

Answer 8

Most common intrarenal aki
Damage to basment membrane of tubular epithelium, necrotic tissue sloughs off , tubules become blocked
Causes- prolonged pre or post renal failure, hemolyzed red blood cells, increase in myoglobin

Question 9

Contrast induced nephropathy

Answer 9

Risk factors- dehydration, hypotension, sepsis, use of nephrotic ix meds, greater than 100 ml of contrast, GED less than 60, or older than 75

Question 10

Aki oliguric phase

Answer 10

Inability to produce urine
Output less than 0.5 ml/kg/hr
Fluid volume overload
Electrolyte imbalances hyperkalemia

Question 11

Aki diuretic phase

Answer 11

Starting to heal
Inability to concentrate urine
Output 3-5 L/ day
Fluid volume deficit
Electrolyte imbalances: hypo atria and hypokalemia (dumping )

Question 12

Aki recovery phase

Answer 12

May take up to 12 months to fully recover from aki

BUN/ creatinine normalize

Question 13

Creatinine clearance

Answer 13

Required 24hr urine collection
Approximates Gfr
70-135mL/min/m2

Question 14

Blood urea nitrogen

Answer 14

6-20mg/dL
Measures urea excretion
Can be influenced by non renal factors infection fever trauma steroid therapy diet

Question 15

Serum creatinine

Answer 15

0.6-1.3 mg/dL
End product of muscle/ protein metabolism
More reliable than BUN
Requires vein puncture

Question 16

Calculated glomerular filtration rate

Answer 16

115mL/min
Based on mdrd equation
Adjusted for gender, African Americans, and age

Question 17

Pre renal diagnostic study

Answer 17

BUN/CR ratio elevated in pre renal

Fraction of excreted sodium normal in pre renal

Question 18

Intrarenal diagnostic study

Answer 18

Intrarenal normal bun/ cr ratio

FEna elevated

Question 19

Urinalysis

Answer 19

Casts= intrarenal failure indicate damage to various parts of tubules
Protein, hematuria, Pyuria, alterations in urine specific gravity

Question 20

Pre renal prevention and early intervention

Answer 20

The #1 cause is priceless

Prevent infection and heavy fluid resuscitation

Question 21

Intrarenal prevention and early intervention

Answer 21

Screen for risk factors in CAM

Treat strep infections

Question 22

Contrast associated nephropathy

Answer 22

Avoid in patients at high risk
Hydrate 12 hrs before and after
Give 3 doses of mycomyst po
Evaluate function for 72 hrs after

Question 23

Nephrotoxic drugs

Answer 23

Aminoglycosides
NSAIDs
Cephalosporins 
Tobramycin
Vancomycin
Chemotherapy 
Norepinephrine
(Monitor trough levels)
75% of meds are metabolized through the kidneys

Question 24

Uremia

Answer 24

Hold on to nitrogenous waste products bun and creatinine

Itchy, drowsy, confused, irritable, decreased mentation, GI disturbances, uremic frost

Question 25

Managing hyperkalemia

Answer 25

Diuretics (lasix)
Polystyrene sulfonate (kayexalate)
Insulin and dextrose
Calcium gluconate- cardiac protective agent doesn’t decrease potassium just makes sure they don’t code

Question 26

When to start dialysis

Answer 26

Volume overload compromising respiratory and cardiac status
Elevated potassium not responding to treatment
Severe metabolic acidosis
Bun 120mg/dL
Significant change in mental status
End of life considerations

Question 27

Dialysis complications

Answer 27

Infection
Hypotension
Blood loss
Bleeding
Hepatitis
Disequilibrium syndrome- happens 1st or 2nd time large amount of solute shifts causes bad headaches and sometimes seizures
Arterial steal syndrome- right after fistula or graft put in do not have good perfusion distal to site

Question 28

Before dialysis

Answer 28

Weight checks, fluid volume status, communicate well with dialysis nurse and pharmacist ask whether you should give meds anti hypertensives usually held

Question 29

After dialysis

Answer 29

Fluid volume status, weight checks

Question 30

Peritoneal dialysis complications

Answer 30

Exit site infection
Peritonitis
Abdominal hernia
Lower back pain
Intraperitoneal bleed
Pulmonary complications
Protein loss

Question 31

Nephron

Answer 31

Does the work and makes the urine