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Renal- PA Sp23 > AKI > Flashcards

AKI Flashcards

1
Q

What is AKI?

A

abrupt loss of renal function

decrease in urine volume
increase in BUN:Cr

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2
Q

What is oliguria?

A

<500cc/ day urine excretion

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3
Q

What is anuria?

A

<50cc/day urine excretion

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4
Q

KDIGO Criteria for AKI

A

-Increase in S. creatinine by >0.3 mg% within 48 hours
OR
-Increase in S. creatinine to >1.5 times baseline that occurred in last 7 days
OR
-Urine volume <0.5 cc/kg/hour for 6 hours

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5
Q

What are the causes of post- renal failure (azotemia)

A

Very common- BPH

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6
Q

What are the clinical findings of post-renal failure?

A
  • Waxing and waning of urine volume
    -Hematuria (normal appearing Rbcs)
  • Flank pain
  • Anuria
  • Bladder distention
  • Ultrasound of kidneys often shows hydronephrosis
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7
Q

What are the causes of prerenal azotemia?

A

“decreased renal perfusion”

volume depletion
excessive intravascular volume
excessive volume outside vascular spaces
Rental artery stenosis BIL

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8
Q

What are the causes of acute renal parenchymal failure?

A

ATN d/t nephrotoxins or ischemia

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9
Q

What conditions respond to volume?

A

physiologic oliguria, pre-renal azotemia

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10
Q

What conditions respond to loop diuretics (but not volume)?

A

Incipient ATN, established ATN

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11
Q

Acute cortical necrosis results in _______ because it does not respond to volume or loop diuretics. It is commonly seen in ____ patients.

A

ESRD, younger

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12
Q

Pathogenesis of oliguria in ATN:

A

1 decreased GFR, decreased filtration s/t decreased perfusion in afferent arteriole

MOA: hemodynamic insuff= tubular ischemia + injury OR nephrotoxins (RT)

1) tubular damage with back diffusion (PCT)
2) Tubular obstruction due to debris (LoH-d)
3) interstitial edema (tissue turgor pressure- DCT)

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13
Q

DDx of Oliguria

A
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14
Q

Does CKD or AKI have a greater degree of hyperkalemia?

A

AKI

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15
Q

Does CKD or AKI have increased phosphorus levels?

A

CKD

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16
Q

Does CKD or AKI have hyperPTH?

A

CKD

17
Q

Does CKD or AKI have a greater degree of anemia?

A

CKD

18
Q

Is CKD or CKD with acute exacerbation a more rapid progression?

A

CKD with AE

19
Q

What are the reversible factors for renal deterioration?

A

this is the order you should see clinically:

20
Q

What is the most common drug to cause acute exacerbation of CRF or AKI?

A

NSAIDs

Others:
vancomycin, IV contrast, aminoglycosides, HIV drugs, acyclovir, cyclophosphamide, acetaminophen, cisplatin

21
Q

If PRA due to hypovolemia, _____ _____.

A

Normal Saline

22
Q

If PRA d/t CHF, ____ _____.

A

Loop diuretics

23
Q

If ATN and hypovolemia, _____ _______. Why cautiously?

A

Normal Saline

Caution should be taken depending on the presentation of the patient. PE will help with cautious administration.

24
Q

If ATN and volume replete, ____ _____.

A

Loop diuretics

25
Q

Should you continue Lasix if no response after maxing the dose out and adding metolazone?

A

No

26
Q

What disease are the following problems associated with?

Hyperkalemia, fluid excess, metabolic acidosis, uremia, hypertension

A

ATN

27
Q

What are the treatments for hyperkalemia?

A
28
Q

How does HTN affect AKI?

A

usually volume dependent
- Controlled with salt and water restriction and loop diuretics or RRT
- initiate/ increase antihypertensives

29
Q

What factors affect the prognosis of AKI?

A
  • severity of underlying disease
  • infection
  • GI heme
  • surgery
  • oliguria or anuria
  • age
30
Q

What are the 2 most common causes of death in AKI?

A

Septicemia (40%) and GI heme (25%)

31
Q

What is the mortality rate in a hospitalized patient with AKI?

A

40-50%

32
Q

What are the indications for Dialysis in a patient with AKI?

A

1) hyperkalemia
2) Pulm edema
3) Profound M. acidosis
4) uremic Si/Sx (encephalopathy, anorexia, N/V, pericardial friction rub, myoclonus or seizure)
5) prophylatic

Renal- PA Sp23 (4 decks)

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