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NUR 746 exam 2 > AKI > Flashcards

AKI Flashcards

1
Q

KDIGO definition for AKI

A

stage 1 - crt 1.5-1.9 x baseline or Cr >0.3; UOP < 0.5 ml/kg/h for 6-12 h

stage 2 - crt 2-2.9 x baseline; UOP < 0.5 ml/kg/h for >12 h

stage 3 - crt >3x baseline OR crt>4, OR initiation of HD; UOP <.3 ml/kg/hr for >24 h or anuria >12 h

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2
Q

anuria

A

no UOP or < 100 ml/24 h

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3
Q

oliguria

A

100-400 mls/24h

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4
Q

polyuria

A

> 6L/24 h

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5
Q

nonoliguria

A

greater than 400 ml/24 h

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6
Q

prerenal AKI tx

A

1-2 L isotonic fluids for hypovolemia

diuretics for hypervolemia

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7
Q

causes of ATN

A

ischemia
nephrotoxins (contrast, meds)

most common type of hospital acquired AKI

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8
Q

causes of AIN

A

infection
drugs - antibiotics (allergic interstitial nephritis)!!!!!! #!
immune disorders

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9
Q

causes of glomerulonephritis

A

damage to filtering mechanisms (immune complex-mediated)

other causes

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10
Q

vascular AKI causes

A

large vessels - renal vein thrombosis, renal artery stenosis

small vessels - vasculitis, atheroembolic, malignancy hypotension, thrombotic microangiopathies (HUS, TTP)

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11
Q

ATN diagnostics

A

BUN:Crt ratio - PRESERVED (10-20:1)
FENa: >1 (when oliguric)
UA - negative protein, negative blood, POSITIVE GRANULAR CASTS (dirty brown), RENAL TUBULAR EPITHELIAL CELLS

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12
Q

RF for contrast-induced AKI

A

(type of ATN)
renal insufficiency
diabetes

multiple myeloma
high osmolar (ionic) contrast media
contrast medium volume
age

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13
Q

contrast-induced AKI characterstics

A

onset 24-48 h after exposure
duration 5-7 d
non-oliguric
tx w fluids & prevention! (500-1000 ml of NS before procedure, during, and after)

hold other nephrotoxic agents 2 days before if high risk

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14
Q

ATN treatment

A

remove offending agent
treat offending cause
maintain renal perfusion
avoid nephrotoxins
diuretics for fluid removal

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15
Q

acute interstitial nephritis

A

renal lesion that causes a decline in renal function

characterized by an inflammatory infiltrate in the kidney interstitial

think inflammatory, hematuria, blood

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16
Q

classic presentation of AIN

A

fever , rash, arthralgias, eosinophilia

(ask about new meds)

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17
Q

AIN diagnostics

A

BUN:Crt <20:1
microscopic hematuria
gallium 67 scan, renal ultrasound
renal biopsy - gold standard
white casts, white cell casts, eosinophils

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18
Q

AIN treatment

A

supportive tx
dx offending agents
manage underlying condition

consider corticosteroids

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19
Q

nephritic vs nephrotic

A

nephritic - think blood
(think inflammation, hematuria)

nephrotic - think protein
(severe proteinuria, edema, hyperlipidemia, hypoalbuminemia)

20
Q

in what syndrome do you see glomerular crescent formation

A

rapidly progressive glomerulonephritis (RPGN)

rapid decline of GFR in 3 month period

21
Q

nephrotic syndrome tx

A

treat underlying cause

reduce BP and cholesterol!

manage edema

22
Q

nephrotic syndrome s/s

A

severe proteinuria (>3g) d/t kidney damage, HLD, edema

dyspnea, abd fullness, edema, pleural effusions

23
Q

glomerulonephritis diagnostics

A

previous infection????

UA - protein, blood RBCs, RBC casts

BUN:Crt ratio preserved

kidney biopsy diagnostic

24
Q

glomerulonephritis treatment

A

treat underlying cause - manage BP?

treat infection

immunosuppression if severe

25
Q

IgA nephropathy

A

berger’s disease

most common cause of primary glomerulonephritis

classic presentation - gross hematuria after URI

26
Q

IgA nephropathy diagnostics

A

gross hematuria within 12-72 hours of infection (viral URI)

proteinuria

kidney biopsy - positive IgA deposits

27
Q

IgA nephropathy tx

A

reduce proteinuria
control HTN

consider prednisone or immunosuppression

may require transplant if severe

28
Q

post renal causes of AKI

A

mechanical (BPH, strictures, tumors, etc)
functional (spinal cord disease, neurogenic bladder, diabetic neuropathy)

29
Q

indications for renal biopsy

A

unexplained AKI/CKD, acute nephritis syndrome, proteinuria/hematuria, previously identified lesion, systemic disease, suspected
transplant rejection, help guide treatment

CI : bleeding, uncontrolled HTN

30
Q

FeNa

A

used to differentiate between prerenal and intrinsic

pre renal <1%

ATN >2

31
Q

lab findings for AKI

A

rising creatinine and urea
rising K
decreasing hgb
acidosis
hyponatremia
hypocalcemia

32
Q

indications for acute dialysis

A

AEIOU

anuria
oliguria
pulmonary edema
hyper K >6.5
severe academies <7.2
uremic encephalopathy
uremic pericarditis

33
Q

when to consult/admit for AKI

A

consult - AKI not reversed after 1/2 weeks (neph), s/s/ of persistent UTI (urologist)

admit - sudden loss of kidney function that cannot be handled op, need for acute intervention

34
Q

acute pyelonephritis

A

acute inflammatory disease that involves renal parenchyma and renal pelvis

E. coli most common bacteria

35
Q

acute pyelonephritis tx

A

fluids

IV abx 48-72 h, then oral

abx depends on pathogen

CTX
fluoroquinolones
zosyn

36
Q

nephrolithiasis s/s

A

renal colic - intermittent back/flank pain with radiation

dysuria, chills, fever, N/V, hematuria

uncomfortable, tachycardia, fever, diaphoresis, CVA tenderness

37
Q

nephrolithiasis management

A

<5 mm will usually pass spontaneously

FLUIDS

if obstruction or accompanying infection - need removal (extra-corporal shock wave lithotripsy, percutaneous access and removal, ureteroscopy)

pain mgmt - NSAIDs

alpha blockers/calcium channel blockers x4 weeks to help stone pass

prevent future stones - diet changes (dec protein)

38
Q

nephrolithiasis

A

kidney stones

calcium oxalate most common

can cause AKI

39
Q

first line dx for nephrolithiasis

A

non contrast spinal CT

hematuria

40
Q

renal artery stenosis

A

renal artery and its branches are potential sites for plaque formation, which can lead to ischemic renal disease and HTN

caused by atherosclerosis

if you can’t get their BP under control - think renal artery stenosis

41
Q

fibromuscular dysplasia

A

unexplained HTN
can lead to renal artery stenosis

42
Q

renal artery stenosis s/s

A

refractory HTN
AKI w initiation of ACE

pulmonary edema
audible abdominal bruit

43
Q

renal artery stenosis diagnostics

A

renal angiography

screening via ultrasound or CT

44
Q

renal artery stenosis mgmt

A

consider revascularization

control HTN, lipids, DM!
ACE, ARB, CCB, statin

45
Q

postrenal diagnostics

A

elevated BUN:creatinine ratio
unremarkable UA
consider renal US/CT for hydronephrosis

NUR 746 exam 2 (8 decks)

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