Acute Kidney Injury and Chronic Renal Failure Lecture Powerpoint Flashcards
9/11/19
Acute Kidney injury is characterized by its ___
fast onset (days to weeks)
Metabolic acidosis is brought on when the kidney is no longer doing what?
Excreting H+ ions and reabsorbing HCO3-
2 values that confirm AKI
- increase in creatinine level
- decrease in urine output
If a patient comes in with a higher creatinine but we don’t know if its their baseline, how do we determine?
Obtain old medical records
1 risk factor for developing AKI is having…
Chronic kidney disease
Mortality rate for severe AKI is up to ___%
60
If AKI requires dialysis, there is a ___ risk of progression to CKD stage IV or V
Increased
When treating AKI, important to avoid ____agents such as NSAIDS, aminoglycosides, ACE inhibitors/ARB’s, and cyclosporines
Nephrotoxic
1 cause of prerenal AKI
Decreased renal perfusion
1 cause of post renal AKI
Obstruction
Prognosis of prerenal AKI
Good, typically does not cause permanent damage if treated
Most common acute tubular necroses are in ____ patients
Hospitalized
Acute Interstitial nephritis treatment (1)
-Corticosteroids
Some common causes of Intrinsic AKI (4)
- glomerulonephritis
- acute tubular necrosis
- acute interstitial nephritis
- renal artery stenosis
Common physical exam findings of AKI (5)
- edema
- confusion
- asterixis
- coke colored urine
- cva tenderness
In assessing AKI you want to determine if it is prerenal or intrinsic renal, how can you do this?
FENa test <1% indicates prerenal cause and >2% indicates intrinsic renal cause
Any patient having kidney issues needs to be on a ___ and ____restricted diet
protein, sodium
Protective IV therapy against hyperkalemia for heart arrhythmia
Calcium gluconate
Treatment for hyperkalemia to increase cellular uptake of potassium is…
….insulin with glucosee IV
IV sodium bicarbonate can be used to treat….
….metabolic acidosis
Indications that AKI warrants dialysis (3)
- metabolic acidosis
- hyperkalemia
- signs of uremia such as asterixis and mental decline
1 cause of acute tubular necrosis is….
…renal hypoperfusion
3 big hormones of the kidney
- calcitriol
- erythropoietin
- renin
Chronic renal failure definition
Process of significant irreversible reduction in number of functioning nephrons characterized by at least 3 months of reduced GFR
2 most common causes of chronic renal failure
- uncontrolled diabetes
- hypertension
2 elements needed to diagnose chronic renal failure
- GFR
- Albuminuria
6 stages of chronic renal failure
G1 - normal renal function >90mL/min G2 G3a G3b G4 G5 - kidney failure, end stage renal disease, GFR <15ml/min
A1 normal to mildly increased albuminuria
A2
A3
Chronic kidney failure in stage G1-G3B are usually ____
asymptomatic
Chronic renal failure involves every organ system, including 2 endocrine ones…
…osteoperososis due to calcitriol lack and anemia due to erythropoietin
Uremic scratching is a finding seen in ___ and define it
Chronic kidney failure, hyper phosphatemia causing itching and scratching on excoriated skin
Treatment for chronic kidney failure includes these 4 classes of meds
- ACE or ARB’s
- diuretics
- Ereythropoietin stimulating agent
- iron supplements
Because someone with CKD has a decline in blood flow to kidney, they may need a ___ dosage of lasix so it can perfuse to the loop of henle
increased
