AKI

Question 1

AKI is a ______ reduction of kidney function causing:

• retention of ____________
• disruptions in ______ , ______ , ______
• increased ____________
• decreased ______

Answer 1

AKI is a sudden reduction of kidney function causing:

• retention of nitrogenous waste products
• disruptions in fluid, electrolyte, acid base balances
• increased serum creatinine
• decreased GFR

Question 2

A decrease in GFR will increase ____________

Answer 2

A decrease in GFR will increase serum creatinine

Question 3

______: elevated levels of nitrogenous waste products (blood urea nitrogen (BUN) and serum creatinine levels)

Answer 3

azotemia

Question 4

______: a buildup of toxins in your blood. It occurs when the kidneys stop filtering toxins out through your urine

Answer 4

uraemia

Question 5

3 sites of disruption (types of AKI)
1.
2.
3.

Answer 5

1. Renal perfusion (pre-renal)
2. Urine flow distal to the kidney (post-renal)
3. Circumstances within the kidney blood vessels, tubules, glomeruli, or interstitium (intrinsic/intra-renal)

Question 6

Renal perfusion (pre-renal):

what conditions can cause diuresis?

Answer 6

• hypovolemia
• hypotension
• heart failure
• fever, vomiting, diarrhea
• burns
• overuse of diuretics
• drugs: ACE inhibitors, angiotensin II blockers, NSAIDs
• diet pills
• caffeine
• alcohol

Question 7

Renal perfusion (pre-renal):

characterised by

Answer 7

• low GFR
• oliguria (low urine output)
• high urine specific gravity and osmolality
• low urine sodium

Question 8

Prolonged renal perfusion (pre-renal) leads to ___________

Answer 8

acute tubular necrosis (intrinsic/intra-renal)

Question 9

Post-renal AKI is due to

Answer 9

due to obstruction within the urinary collecting system distal to the kidney; elevated pressure in Bowman’s capsule; impedes glomerular filtration

Question 10

Prolonged Post-renal AKI leads to ___________; and if continues leads to ________

Answer 10

acute tubular necrosis (intrinsic/intra-renal);

irreversible kidney damage

Question 11

Intrinsic/intra-renal AKI is due to

Answer 11

pri disfunction of nephrons and kidney

Question 12

What are the causes of intrinsic/intra-renal AKI?

Answer 12

• nephrotoxic insults (eg. contrast media)

- ischaemic insults (eg. sepsis)

Question 13

Sepsis produces ________ by provoking a combi of systemic ________ & intra-renal ________.

Answer 13

Sepsis produces ischemia by provoking a combi of systemic vasodilation & intra-renal hypoperfusion.

Question 14

Sepsis also results in production of ________ & ________

Answer 14

toxin & fats

Question 15

Pathological processes in Intrinsic/intra-renal AKI:

1. ________ & ________ intraluminal pressure, thus ________ glomerular filtration
2. Afferent arteriolar ________, thus ________ glomerular capillary filtration pressure
3. Tubular injury & ________ intraluminal pressure, thus ________

Answer 15

1. Obstruction & increased intraluminal pressure, thus decreased glomerular filtration
2. Afferent arteriolar vasoconstriction, thus decreased glomerular capillary filtration pressure
3. Tubular injury & increased intraluminal pressure, this back leak

Question 16

3 phases of acute tubular necrosis (intrinsic/intra-renal)

Answer 16

1. prodromal
2. oliguric
3. postoliguric

Question 17

prodromal phase:

• normal or decreased ______
• increased ______ and ______
• duration: ______

Answer 17

prodromal phase:

• normal or decreased urine output
• increased BUN and creatinine
• duration: depends on cause of injury, severity of hypertension, etc

Question 18

oliguric phase:

• vol. ______
• hyperkalemia
• azotemia/uremia
• metabolic acidosis
• duration: ______
• urine output: ______mls/day
• fluid excess
• ______ may be required

Answer 18

oliguric phase:

• vol. overload
• hyperkalemia
• azotemia/uremia
• metabolic acidosis
• duration: up to 8 wks
• urine output: 50-400mls/day
• fluid excess
• dialysis may be required

Question 19

postoliguric phase:

• fluid vol ______
• labs begin to ______

Answer 19

postoliguric phase:

• fluid vol deficit
• labs begin to normalise

Question 20

Prerenal vs intra renal/intrinsic:

1. Proteinuria
2. Urine sodium conc.

Answer 20

Prerenal–

1. Proteinuria: absent
2. Urine sodium conc.: <10 mmol/L

Intrinsic–

1. Proteinuria: possible
2. Urine sodium conc.: >20 mmol/L

Question 21

Is AKI reversible?

Answer 21

Yes, but could progress to renal failure, which is irreversible

Question 22

Impt AKI nursing management (pt 1)

• vital signs (esp for ______, ______)
• I/O
• urine colour
• daily weight (increase in ______kg/day indicate ______)
• monitor for altered lvl of ______ caused by uremia
• monitor blood results such as BUN creatinine, electrolyte lvls

Answer 22

• vital signs (esp for hypertension, tachy)
• I/O
• urine colour
• daily weight (increase in 1-2kg/day indicate fluid retention)
• monitor for altered lvl of consciousness caused by uremia
• monitor blood results such as BUN creatinine, electrolyte lvls

Question 23

Impt AKI nursing management (pt 2)

• monitor urinalysis for protein lvl, hematuria casts & gravity
• monitor for signs of ______ (high WBC)
• monitor lungs for ______ and ______ (indicate ______)
• provide ______ protein diet to decrease workload on kidneys

Answer 23

• monitor urinalysis for protein lvl, hematuria casts & gravity
• monitor for signs of infection (high WBC)
• monitor lungs for wheeze and rhonchi edema (indicate fluid overload)
• provide moderate protein diet to decrease workload on kidneys