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7320 > AKI > Flashcards

AKI Flashcards

1
Q

what is the functional unit of the kidney?

A

nephron: bowmans cap, prox conv tube, loop og hen, distal tube, collecting duct

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2
Q

the spontaneous mvmnt of fluid from area of higher concentration to lower is?

A

Diffusion

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3
Q

where does the concentration and dilution of urine occur?

A

juxtamedullary nephrons

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4
Q

the function of aldosterone is primarily?

A

control Na and H2O

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5
Q

when renin is released the physiologic effect is?

A

vasoconstriction

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6
Q

when hypotension occurs, which helps mntn adequate glomerular pressure?

A

constrict efferent arteriole

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7
Q

the beginning of filtration at each nephron occurs at the?

A

glomerulus

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8
Q

what will result in increased release of renin?

A

reduced pressure in glomerulus

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9
Q

after angio 1 to angio 2, the adrenal glans are stimulated to secrete?

A

aldosterone

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10
Q

increased secretion of ADH =

A

increased resorption of H2O in collecting duct

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11
Q

GFR is influenced by

A

blood flow through the glomerulus (rate)

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12
Q

what things would decreased the GFR?

A

low BP,
obstruction of flow of filtrate in the tubules,
low plasma oncotic pressure

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13
Q

the best indicator of glomerular filtration rate (and therefore function) is?

A

creatinine clearance test

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14
Q

what % of bicarb is reabsorbed from the filtrate?

A

90%

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15
Q

in the presence of renal ischemia or injury, what might occur

A

metabolic acidosis

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16
Q

if the loop of henle was damaged, what would you see

A

dilute urine

17
Q

the functions of the proximal con tubule include?

A
  • resorption of H2O, Na, K, Cl, HCO3, amino acids and urea
18
Q

the main function of the collecting duct include?

A
  • H2O resorption in the presence of ADH
  • resorption/ secretion of H+ ions and HCO3
  • concentration of urine by resorption of H2O by water osmosis
19
Q

how do the kidneys respond to low perfusion

A

-RAAS activation by juxtaglomerular apparatus

decreased perfusion to kidneys = RASS active = angio 1- angio 2 (in lungs).

  • angio 2 - potent vasoconstrict (constricts efferent arterioles)= increase afterload and increases BP
  • angio 2 stimulates adrenal gland to release aldosterone = retains Na and H20
20
Q

5 major renal fnctn

A
  1. fluid and electrolyte balance
  2. acid-base balance
  3. metabolic waste excretion
  4. bp regulation
  5. endocrine reg (erythropoietin, vit D)
21
Q

risk factors AKI

A
  • sepsis
  • nephrotoxic drugs: mycin’s, penicillins, cyclosporins, corticosteriods, lasix, contrast dye
  • other drugs: NSAIDS, ACE-inhibit
  • intra- abd compression
  • rhabdomylosis- myoglobin from skeletal muscle inj
22
Q

Physical assess includes

A
  • visual flank/abd
  • preload: JVD, skin turgor, mucus membranes, edema, dypnea
  • auscultate: extra heart sounds, crackles

vol status

23
Q 
R
I
F
L
E
A 
risk
injury
failure
loss
end stage
24
Q

creatinine

A
  • *most reliable**
  • biproduct of muscle metabolism
  • filtered by glomerulus (intrarenal)**, not reabsorbed
  • caused by: kidney failure due to impaired excretion, catabolic states (excess training with poor nutrition)
25
Q

Urea

A
  • by-product of protein metabolism
  • secreted in proximal tubule
  • reabsorbed in collecting ducts to aid in water resorption(used in osmosis to increase solute in filtrate/blood stream)
26
Q

BUN: Cr ratio

A

10-20 : 1

  • when BUN is much higher than Cr, we know that blood is going slower through the nephron, allowing for increased resorption of BUN (hence renal perfusion is diminished)
  • when ratio is increased = renal hypoperfusion
  • when ratio is decreased = intrarenal injury = the nephron is not resorbing the urea a the tubules
27
Q

Creatinine clearance test

A
  • 24 hr collection
  • BEST for renal function** most accurate
  • compares Cr excreted in urine to serum Cr and calculates GFR
  • decreased Cr = decreased renal perfusion

sometimes this is reported as the eGFR

28
Q

GFR

A

How much blood passes through urine per min

29
Q

anion gap

A

the diff btwn measurable cations (Na, K) and anions (HCO3, CL) in serum

normal 1-12

looking at metabolic disturbances

30
Q

BUN:CR ratio

A

BUN 20-30 : Cr 1

If BUN 30 : Cr 1 = hypo perfusion = pre-renal

If BUN 10 : Cr 1 = hyper perfusion = intrarenal. This would mean the nephron is not resorbing the urea at the tubules = dead kidney

7320 (8 decks)

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