AKI and CKD Flashcards
specifics of kidney injury
–kidneys are needy
–injury can be sudden and rapidly progress
–reversible
renal insufficiency numbers
25% of normal GFR (>90% = normal)
acute kidney injury
–result of ischemic injury r/t loss of volume –> decreased perfusion
what are common consequences of AKIs?
toxins or sepsis
prerenal AKI
before kidneys; volume loss related
examples of prerenal AKI causes
–blood loss
–dehydration
intrarenal AKI causes
directly kidneys; acute tubular necrosis
postrenal AKI causes
not as common; obstruction causing cell death (blockage, tumor)
symptoms of AKIs
–oliguria
–begins 1 day after hypotensive event and lasts 1-3 weeks
–fluid volume excess
–metabolic acidosis
–hyponatremia
–hyperkalemia
–waste product accumulation
–neuro disorders
amounts that specify for oliguria
<400mL/day, <30mL/hr
treatment for AKIs
–address the cause
–treat manifestations
–monitor labs
–avoid nephrotoxic drugs
manifestations in CKD stages 1 and 2
asymptomatic
manifestations in CKD stage 3
HTN
stage 4 CKD
–symptomatic
–diagnosis
stage 5 CKD
–GFR < 15
–uremic
uremic
urea in blood; accumulation of waste products in blood
causes of ESRD
–diabetes (50%)
–HTN (30%)
–Glomerulonephritis (10%)
–Other (10%)
risk factors for CKD
–family history
–increasing age (>60)
–male
–Black/African American
–HTN, DM, smoking
–overweight and obesity
most apparent signs of worsening CKD
–proteinuria
–increased angiotensin II
how to monitor for worsening CKD
monitor BP and UOP
what is special about the pathogenesis of CKD?
cyclical process
psychologic symptoms of CKD
–anxiety
–depression
CV symptoms of CKD
–HTN
–heart failure
–coronary artery disease
–pericarditis
–peripheral artery disease
GI symptoms of CKD
–anorexia
–nausea
–vomiting
–GI bleeds
–gastritis
Neuro symptoms of CKD
–fatigue
–headache
–sleep disturbances
–encephalopathy
pulmonary edema in CKD
–bad sign
–dialysis
Integumentary symptoms of CKD
–pruritis
–ecchymosis
–dry, scaly skin
symptoms associated with kidneys no longer maintaining F&E homeostasis
–edema
–hyperkalemia
–hyperphosphatemia
–hypermagnesemia
–metabolic acidosis
symptoms associated with kidneys no longer ridding body of wastes via urine
–anorexia
–malnutrition
–itching (toxin buildup)
–CNS changes (azotemia)
symptoms associated with kidneys no longer producing enough erythropoietin
anemia
symptoms associated with kidneys no longer activating enough vitamin D
renal osteodystrophy
what can drugs be used to do with CKD?
–slow the rate of progression
–treat complications
components of slowing the rate of progression of CKD
–reduce BP to less than 140/90 (slow titration to normal)
–treat hyperlipidemia (<200)
blood pressure control in CKD
–ACE or ARB
–other BP meds as needed to maintain SBP (110-130)
lipid control in CKD
statins as needed; diet control
how to treat volume overload in CKD
loop diuretic; low-salt diet
how to treat hyperkalemia in CKD
–diuretics
–kayexalate
–addressed with hemodialysis in ESRD
how to treat metabolic acidosis in CKD
–sodium bicarb
–alkaline agent
how to treat hyperphosphatemia in CKD
–calcium carbonate
–phosphate binder
how to treat renal osteodystropy in CKD
–calcitriol
–activated vitamin D
how to treat anemia in CKD
–erythropoietin
–black box warning
goals of sodium bicarb
–slow progression of CKD
–prevent bone loss
–improve nutritional status
use of sodium bicarb
to treat metabolic acidosis
what does an alkalinic agent do?
increased pH
specifics of sodium bicarb
–given PO
–initiate when HCO3 < 15
goal of HCO3
18-20
side effect of sodium bicarb
bloating
purpose of calcium carbonate
treat hyperphosphatemia
MOA of calcium carbonate
binds to phosphate
goals of calcium carbonate
–keep normal phosphate levels
–decrease mortality
adverse effects of calcium carbonate
hypercalcemia –> monitor calcium levels
when should calcium carbonate be taken?
with meals
purpose of calcitriol
treat renal osteodystrophy
MOA of calcitriol
–activated form of vitamin D
–stimulate intestinal absorption of calcium/phosphate and bone mineralization
adverse effects of calcitriol
–hypercalcemia
–hyperphosphatemia
drug therapy in CKD specifics
–many kidneys are excreted through the kidneys
–drug doses and frequency may be adjusted (renal dosing)
drugs of concern with CKD
–digoxin
–diabetic agents (metformin)
–antibiotics (vanc)
–opioids (morphine)
concern with opioids in CKD patients
greater chance of respiratory distress because the drug doesn’t leave their system as quickly
