Acute Kindney Injury - Class Exercise

Question 1

The patient presents with
Cr = 2.5
BUN = 80 (6-24)
K = 6
BP = 80/60

Calculation of CrCl

Answer 1

-CrCl should be calculated only if the SCr is stable (at normal value???)

Question 2

Lisinopril
Xarelto
Atorvastatin
Pip/Tazo
Carvedilol
Chlorthalidone
Vancomycin
Meloxicam
Furosemide

What changes should be made in a patient with AKI?

Answer 2

-Diuretics: pre-renal AKI
-Vancomycin: ATN
-Xarelto: renal elimination -> risk of bleeding
-Meloxicam (NSAID): pre-renal: decreases perfusion by vasoconstriction of the afferent arteriole
-Carvedilol: lowers BP, possibly decreases perfusion of the kidney
-Pip/Tazo (ß-lactam antibiotic): AIN

Question 3

How to determine which type of AKI affects the kidney?

Answer 3

-Calculate BUN:SCr if greater than 20
-Calculate FeNa if less than 1%

Fe (fraction of excretion): if a patient is dehydrated, the body keeps Na and FeNa will be low ( less than 1%)

for pre-renal: Urinalysis, FeNa, Fe(Urea), BUN:SCr

Question 4

What are the signs indicating pre-renal AKI?

Answer 4

-BUN:SCr greater than 20 (32)
-FeNa less than 1% (0.92)
-low BP (80/60) due to dehydration

Question 5

How to treat the patient with pre-renal AKI?

Answer 5

-give IV fluids
-stop diuretics (the fluids would be pee’d out)
-stop Carvedilol (a good drug for heart failure long-term, for now, it should be stopped and started later)
-Vancomycin: monitor troughs
-Xarelto: dose adjust bc it is cleared by the kidney (risk of bleeding), not bc it is nephrotoxic
-Pip/tazo: can cause AIN but is also cleared by the kidney -> dose adjust or stop

Question 6

How to determine if a patient needs Dialysis?

Answer 6

A, E, I, O, U
Acidosis
Electrolyte abnormalities
Intoxication
Overload of volume: patient cant urinate
Uremia

Question 7

How do characteristics of a drug affect drug removal in a dialysis patient?

Answer 7

high MW: low drug removal
low Vd: hydrophilic -> high drug removal
high protein binding low drug removal

Question 8

A patient on dialysis suffers from hypotension, which drugs might help?

Answer 8

Midodrine (alpha-1-agonist) -> peripheral vasoconstriction

Question 9

Peritoneal vs Hemodialysis

Answer 9

Peritoneal can be more gentle bc the rate of exchange is adjustable, it is every day but at home,
Peritoneal is done in the stomach

-Hemodialysis more likely causes hypertension???
-both have the risk for an infection

Question 10

Which drugs to use for peritonitis?

Answer 10

-infection of the peritoneal cavity
-signs: after the procedure, the patient is febrile, with tachycardia, abdominal distention, and pain

-Ceftriaxone (Rocephine): covers Strep, MSSA, common gram-positive and negative, NO MRSA, no Pseudomonas

Skin and Strep should be covered!