advanced exam 1- Acute kidney injury Flashcards
definition
rapid loss of kidney function
severity of damage to kidneys depends on
duration of being deprived of oxygen, severity of AKI and age
classification of AKI
50% of function or increase in serum creatinine above patient’s baseline
prerenal AKI
hypoperfusion of blood to kidney
decrease in blood therefore oxygen to kidneys
causes of pre renal AKI
volume depletion impaired cardiac efficiency vasodilation hypotension renal artery stenosis
intrarenal AKI
direct damage to kidney tissue
causes of intrarenal
acute tubular necrosis
radiopaque dyes
Rhabdomyolysis
acute glomerulonephritis
types of acute tubular necrosis
ischemic acute tubular necrosis
toxic acute tubular necrosis
ischemic acute tubular necrosis causes
damage to tubules because of inadequate perfusion
examples of ischemic acute tubular necrosis
renal artery stenosis, hypotension and blood loss
causes of toxic acute tubular necrosis
nephrotoxic drugs
nephrotoxic drugs
- antibiotics- amino glycosides (gentamicin and tobramycin) and cephalosporins (cefazolin)
- immunosuppressants (cyclosporine)
- antifungals- amphotericin B
- antivirals- acyclovir
- nephrotoxic chemotherapeutics- 5-azacitidine, cisplatin, methotrexate
- street drugs- heroin, amphetamines, PCP
- analgesics- NSAIDs
post renal AKI
obstruction of urine flow in either ureters, bladder, or urethra
causes of postrenal
obstruction distal to kidneys- kidney stones, enraged prostate, pelvic trauma
pathophysiology of AKI
sudden decrease in kidney function
glomerular and/or tubular dysfunction
phases of AKI
oliguria
diuresis
recovery
oliguric phase
labs: BUN, creatinine, specific gravity, K, GFR
urine output
diuresis phase
labs- ^ in GFR, improved BUN and creatinine
urine output- ^; 10 L/day
assess for dehydration- mucus membranes, skin, disorientation, decreased BP, ^HR, weight loss
recovery phase
increased renal function
labs- decreased BUN and creatinine
urine output- more quality urine
duration varies from 3mo-12mo
clinical manifestations of AKI
CNS- confusion; varies by cause
increased potassium
Lab Diagnostics- BUN
increased levels;
high protein diet may be a possible cause
(breakdown of protein)
Lab Diagnostics- creatinine
increased levels
creatinine is only excreted through the kidneys
(breakdown of skeletal muscle)
Lab Diagnostics- creatinine clearance
in values are decreased then GFR and kidney function are decreased
(measures GFR in 24 hr period)
