AKI Flashcards
AKI due to scleroderma (scleroderma renal crisis) should be treated with
ACE inhibitors.
for hepatorenal syndrome:
Bridge therapies that have shown promise include terlipressin (a vasopressin analog), combination therapy with octreotide (a somatostatin analog) and midodrine (an a1-adrenergic agonist), and norepinephrine, in combination with what intravenous fluid?
albumin (25–50 g, maximum 100 g/d)
Idiopathic TTP-HUS is a medical emergency and should be treated promptly with
plasma exchange
Early and aggressive volume repletion is mandatory in patients with rhabdomyolysis, who may initially require
10 L of fluid per day
Alkaline fluids may be beneficial in preventing tubular injury and cast formation, but carry the risk of worsening _______.
- 75 mmol/L sodium bicarbonate added to 0.45% saline
* hypocalcemia
According to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines, patients with AKI should achieve a total energy intake of
20–30 kcal/kg per day
Protein intake should vary depending on the severity of AKI: 0.8–1.0 g/kg per day in noncatabolic AKI without the need for dialysis; 1.0–1.5 g/kg per day in patients on dialysis; and up to a maximum of ______ if hypercatabolic and receiving continuous renal replacement therapy.
1.7 g/kg per day
a technology similar to hemodialysis except at lower blood flow and dialysate flow rates.
CRRT Continuous renal replacement therapy can also be performed by diffusive clearance (continuous venovenous hemodialysis [CVVHD]
in which large volumes of plasma water (and accompanying solutes) are forced across the semipermeable membrane by means of hydrostatic pressure;
Continuous renal replacement therapy (CRRT) can be performed by convective clearance (continuous venovenous hemofiltration [CVVH]
A hybrid therapy combines both diffusive and convective clearance
continuous venovenous hemodiafiltration [CVVHDF]
To achieve some of the advantages of CRRT without the need for 24-h staffing of the procedure, some physicians favor _____ or extended daily dialysis (EDD).
In this therapy, blood flow and dialysate flow are higher than in CVVHD, but the treatment time is reduced to ≤12 h.
slow low-efficiency dialysis (SLED)
If available, is often preferred in patients with severe hemodynamic instability, cerebral edema, or significant volume overload.
CRRT
Continuous renal replacement therapy
Common causes of community-acquired AKI include
volume depletion heart failure adverse effects of medications obstruction of the urinary tract malignancy
The most common clinical settings for hospital-acquire AKI are
sepsis
major surgical procedures
critical illness involving Heart or liver failure
nephrotoxic medication administration
is the most common form of AKI. It is the designation for a rise in SCr or BUN concentration due to inadequate renal plasma flow and intraglomerular hydrostatic pressure to support normal glomerular filtration
Prerenal azotemia
Prolonged periods of prerenal azotemia May lead to ischemic injury, often termed
acute tubular necrosis (ATN)
Glomerular filtration can be maintained despite reduced renal bloodflow by _____, which-maintains glomerular capillary hydrostatic pressure closer to normal and thereby prevents marked reductions in GFR if renal blood flow reduction is not excessive
angiotensin II–mediated renal efferent vasoconstriction
Intrarenal biosynthesis of vasodilators such as____
increase in response to low renal Perfusion pressure
prostaglandins(prostacyclin, prostaglandin E2), kallikrein and kinins,and possibly nitric oxide (NO)
Even in healthy adults, renal autoregulation usually fails once the systolic blood pressure falls below
80 mmHg
