AKI and CKD Flashcards
Kidney Functions (3)
- Maintain fluid and electrolyte
homeostasis - Rid the body of water-soluble wastes
via urine - Three important endocrine functions:
-Produces erythropoietin- stimulates RBC production
-Activates Vitamin D
-Produces renin, which helps regulate blood pressure
Acute Kidney Injury: AKI
Classifications (3)
3 classifications:
* Pre-renal: volume loss related
* Intrarenal: acute tubular necrosis [chemical, kidney cell death]
* Post-renal: not as common, obstruction causing cell death
Acute kidney Injury
Usually the result of:
Usually the result of ischemic injury r/t loss of volume leads to decreased perfusion
* Toxins or sepsis common causes also
Kidney function can be mildly affected to severe
AKI: Clinical Manifestations
Oliguria (< 400 ml/24 hr)
Begins 1 day after hypotensive event & lasts 1-3 weeks
Fluid volume excess
Metabolic acidosis
Hyponatremia
Hyperkalemia
Waste product accumulation
Neurologic disorders
Risk factors for CKD
Family history
Increasing age (>60)
Male
Black/African American
HTN, DM, smoking
Overweight and obesity
CKD: Manifestations
No longer maintains F&E homeostasis
* Edema, hyperkalemia, hyperphosphatemia, hypermagnesemia, metabolic acidosis
No longer rids the body of waste via urine
* Anorexia, malnutrition, itching, CNS changes
Decreased production of erythropoietin
* Anemia
Decreased activation of Vitamin D
* Renal osteodystrophy
CKD Drugs can be used to:
Slow the rate of progression of CKD
* Reduce BP to less than 140/90
* Treat hyperlipidemia (cholesterol less than 200)
Treat the complications of CKD
* Volume overload
* Hyperkalemia
* Metabolic acidosis
* Hyperphosphatemia
* Renal osteodystrophy
* Anemia
Slowing the Progression of CKD
2 ways
Blood pressure control
* ACE or ARB
* Other BP meds as needed to maintain SBP (110-130) 140
Lipid control
* Statins as needed
Treating Complications of CKD
Volume Overload
* Loop diuretic-used with a low-salt diet Hyperkalemia
* Multiple (ex.=diuretic)-Addresssed with hempdialysis in ESRD
Metabolic acidosis
* Sodium bicarbonate- an alkaline agent Hyperphsophatemia
* Calcium carbonate- a phosphate binder
Renal osteodystrophy
* Calcitriol-activated vitamin D
Anemia
* Erythropoietin- Black box warning!
Sodium Bicarbonate
To treat metabolic acidosis
Goals:
-Slow progression of CKD
-Prevent bone loss
-Improve nutritional status
Given PO
Initiate when HCO3 is less than 15 mEq/mL
-Goal HCO3 18-20
Side effect: bloating
Calcium Carbonate [Tums]
To treat hyperphosphatemia
MOA: Binds to phosphate [phos binder]
Goals: Keep normal phosphate levels,
decrease mortality
Take with meals
Adverse effect: hypercalcemia (monitor
calcium levels)
Calcitriol
1, 25-dihydroxyvitamin D
Used to treat renal osteodystrophy
MOA: activated form of vitamin D; stimulate intestinal absorption of calcium/phosphate and bone mineralization
Adverse effects:
-Hypercalcemia, hyperphosphatemia
Complications of Drug Therapy
Many drugs are excreted through the kidneys
What happens if drug elimination is decreased?
Drug doses and frequency may be adjusted
Drugs of particular concern:
-Digoxin
-Diabetic agents (glyburide, metformin)
-Antibiotics (Vancomycin)
-Opioids (morphine)
Hypercalcemia and Kidneys
Excess calcium in your blood means your kidneys have to work harder to filter it. This can cause excessive thirst and frequent urination.
Hypercalcemia and Digestive System
Hypercalcemia can cause stomach upset, nausea, vomiting and constipation.
