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2 - CPR (renal) > AKI and CKD > Flashcards

AKI and CKD Flashcards

1
Q

Any of what 3 things can define an Acute Kidney Injury (AKI)?

A
  1. Increased Creatinine by > 0.3 in 48 hours
  2. Increased Creatinine to > 1.5X baseline in 7 days
  3. Urine volume < 0.5mL/hour for 6 hours
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2
Q

Any of what 3 things can define an AKI?

A
  1. Increased Creatinine by > 0.3 in 48 hours
  2. Increased Creatinine to > 1.5X baseline in 7 days
  3. Urine volume < 0.5mL/hour for 6 hours
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3
Q

Creatinine levels are affected by muscle mass and other things, what is it used to calculate?

A

Estimated Glomerular Filtration Rate

eGFR

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4
Q

When is the eGFR NOT very accurate?

A

With fluctuating renal function – as in an AKI

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5
Q

As Creatinine increases, eGFR will?

A

Decrease

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6
Q

AKIs are usually ______

A

Asymptomatic

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7
Q

What are possible signs of an AKI?

A

Asterixis

Uremic Frost

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8
Q

With an AKI it can lead to what things generally?

A

Volume overload
Electrolyte and Acid/Base disturbances
Retention of urea and waste products

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9
Q

What are some other manifestations of an AKI?

A

Edema – volume overload
Arrhythmias – electrolyte/acid/base changes
Uremia – retention of waste

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10
Q

Symptoms of uremia?

A

N/V, diarrhea, metallic taste in the mouth, confusion

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11
Q

Pre-Renal AKI

A

Decreased renal blood flow

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12
Q

What are the most common causes of a Pre-renal AKI?

A
  • Hypovolemia = N/V, diarrhea, hemorrhage

- Hypervolemia = CHF

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13
Q

Pre-Renal AKI urine Na level

A

< 20

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14
Q

Pre-Renal AKI BUN/Cr ratio

A

> 20:1

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15
Q

Pre-Renal AKI Uosm

A

> 500

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16
Q

Intrinsic AKI

A

Damage to glomerulus/tubules/interstitium of kidney

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17
Q

What are 2 common causes of an Intrinsic AKI?

A

ATN - acute tubular necrosis

AIN - acute interstitial nephritis

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18
Q

How does Acute Tubular Necrosis arise?

A
  • Prolonged pre-renal AKI or toxin exposure
  • Ischemia
  • Necrosis
  • Debris obstructing tubular flow
  • Decreased GFR
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19
Q

What is the most common cause of Acute Tubular Necrosis?

A

Sepsis

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20
Q

What does the UA show with Acute Tubular Necrosis?

A
  • Renal epithelial cells
  • Granular casts
  • Muddy brown
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21
Q

What usually causes Acute Interstitial Nephritis?

A

Meds - PPIs, antibiotics, NSAIDs

22
Q

What cells infiltrate and what will be seen on UA with Acute Interstitial Nephritis?

A

Immune cells infiltrate

– WBC, eosinophils on UA

23
Q

Intrinsic AKI urine NA level

A

> 40

24
Q

Intrinsic AKI BUN/Cr ratio

A

< 15:1

25
Q

Intrinsic AKI Uosm

A

< 350

26
Q

Post-Renal AKI

A

Obstruction of urinary flow

– Bilateral ureters or bladder outlet

27
Q

What are the most common causes of Post-Renal AKIs?

A

BPH
Blood clots
Stones
Compression

28
Q

In all patients with an AKI, what tests should you at least get?

A

BMP

UA

29
Q

What is the purpose of the Fractional Excretion of Sodium test (FENa)?

A

Differentiates between a Pre-Renal AKI and Acute Tubular Necrosis (ATN)

30
Q

How is FENa calculated?

A

Na excreted/Na filtered

31
Q

FENa < 1%

A

Pre-Renal AKI

32
Q

FENa > 2%

A

Acute Tubular Necrosis

33
Q

If the patient is using _____ use the FEUrea instead

A

Diuretics

34
Q

FEUrea < 35%

A

Pre-Renal AKI

35
Q

FEUrea > 50%

A

Acute Tubular Necrosis

36
Q

Treatment of an AKI depends on the cause. Is there a specific GFR or Creatinine cutoff for dialysis?

A

NO

37
Q

What are some dialysis indications?

A 
A - Acidosis
E - Electrolytes
I - Intoxication
O - Overload
U - Uremia (encephalopathy/pericarditis)
38
Q

If the AKI lasts more than 3 months, what is it now?

A

CKD (chronic kidney disease)

39
Q

If the GFR < 60, there is evidence of kidney damage and it has been < 3 months, what is the dx?

A

AKI

40
Q

Stage 1 and 2 of CKD are not actually CKD if there is no?

A

No kidney damage

41
Q

Stages of CKD with GFRs

A 
1 - > 90
2 - 60-89
3a - 45-59
3b - 30-44
4 - 15-29
5 - < 15
42
Q

What are the 2 main causes of CKD?

A

Diabetes and HTN

43
Q

What are the 2 main causes of CKD?

A

Diabetes and HTN

44
Q

How does CKD arise?

A
  • Damage to nephrons and they die
  • Hyperfiltration/hypertrophy of remaining nephrons
  • Glomerular damage
45
Q

CKD is usually _____

A

Asymptomatic

46
Q

CKD can have all the same manifestations of AKI plus what 2?

A

Anemia

Bone pain and fragility

47
Q

Why is Anemia present with CKD?

A

Decreased EPO and Iron

48
Q

Why is Bone pain/fragility present with CKD? And list molecular changes

A

Decreased 1,25(OH)^2D
=> hypocalcemia
=> secondary hyperparathyroidism
– elevated PTH and phosphorus

49
Q

What is a manifestation of the bone pain/fragility with CKD?

A

Osteitis Fibrosis Cystica

50
Q

What will be seen with Osteitis Fibrosis Cystica?

A

Brown (hemorrhages) tumors in bone
Bone cysts
Subperiosteal bony reabsorption
Fractures

2 - CPR (renal) (27 decks)

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