AKI Flashcards
define an acute kidney injury
- sudden deterioration of kidney function
- is a spectrum of injuries
how does a prerenal AKI present itself
- caused by reduced blood flow/oxygen
- hypovolemia and hypovolemic shock
- decreased CO (MI, HF, carcinogenic shock)
- decreased peripheral vascular resistance (septic shock, vasodilation)
how does a intrarenal AKI present itself
- damage to kindeys
- prologned ischemia
- nephrotoxins
- hemoglobin or myoglobin
- medciations (ACE and ARBs - if already on them for long term)
how does a postrenal AKI present itself
- obstruction of UT
- blocked catheters
- enlarged prostate
- tumors
- non fixed UTI
what are the phases of AKI
- onset phase
- oliguric phase
- diuretic phase
- recovery phase
what is the primary function of the kidneys
- filter waste from circulation
- maintain fluid and electrolyte and acid base balance
- excrete wastes
oliguria
- low urine output with stable creatinine
what is the secondary function of the kidneys
- regulates blood pressure
- bone density
what is non-oliguria
- elevated creatinine with normal urine outpuit
during oliguric phase what electrolyte distrubances will we see
- hyperkalemia
- hyperphosphatemia (increased production of bone breakdown)
- hypocalcemia (decreased Vit. D)
- low sodium
fluid volume overload due to AKI we will see
- JVD
- edema
- pleural effusion
- increased preload
what are risks when in the diuretic phase
- dehydration, hypovolemia and hypotension due to decreased volume (being excreted)
- hyponatremia and hypokalemia
diagnostics for AKI
- GFR
- Creatinine
- BUN
- HCO3 levels
- Renal ultrasound
- Renal CT
what does GFR show
- decrease in cardiac output
- due to either hypotension or hypovolemia
creatinine levels indicates
- GFR fails - not filtered so stays in
- muscle break down
BUN levels show
- late indicator of kidney injury
- medications, high protein diets, trauma, and infection affect it
what treatment do we do if not enough CO or perfusion
- IV fluids (crystalloids isotonic)
- diuretics - if not oliguric
what to do if experiencing hyperkalemia
- stablilize myocardium - ECG stat and give calcium gluconate IV if changes happen
- IV insulin and IV glucose (shift K into cells)
- potassium removal (kayexalate)
what is dialysis
- removal of wastes and fluid form blood
hemodialysis
- blood pumped through filter
- removes urea and uric acid
- balances electrolytes
- 3x a week
- hypotension is a complication
peritoneal dialysis
- used for non renal injuries
- removal done through peritoneal fluid
- night time
- many complications - abdominal pain, respiratory, hypotension
how do you diagnose the cause:
S: Sepsis and hypoperfusion (prerenal)
T: toxicity
O: obstruction (post renal)
P: Primary renal (intrarenal)
