AKI and CKD

Question 1

List prerenal causes of AKI

Answer 1

Heart failure
hypovelemia
Low BP- shocks, burns, sepsis, anaphylaxis
Hemorrhage/blood loss

Question 2

List intrarenal causes of AKI

Answer 2

Acute Tubular Necrosis= #1
Nephrotoxic meds
Contrast dye

Question 3

List postrenal causes of AKI

Answer 3

Kidney stones
BPH
Tumors

Question 4

Explain Oliguric AKI

Answer 4

Starts 1-7 days post-injury
Lasts 10-14 days
UOP <400 mL/day
High creatinine

Casts, metabolic acidosis, hyperkalemia, elevated BUN/urea affects LOC

Restrict fluids

Question 5

Explain Diuretic AKI

Answer 5

Daily UOP 1-3 L, may reach 5L

Hypovolemia, low BP, Na loss, K loss

May need stabilizing fluids/lytes

Question 6

Explain Recovery AKI

Answer 6

Begins with GFR begins to increase

May take up to 12 months
Not everyone recovered (older adults)- ESRD progression

Question 7

What is the goal of AKI treatment?

Answer 7

Eliminate the cause, management, prevent complications

Question 8

Explain nutritional concerns for AKI

Answer 8

AKI is hypermetabolic, catabolic state- burning protein fast

Must increase calories, protein, carbs, fat

Restrict Na, K depending on labs

Question 9

What is the first sign of hypokalemia on an ECG?

Answer 9

Large U wave

Question 10

What is the #1 risk factor for CKD? Others?

Answer 10

1: diabetic nephropathy

Chronic HTN
Age > 60
CV disease
nephrotoxic drugs
Family history/genetics

Question 11

When is CKD diagnosed? When is ESRD diagnosed?

CKD is mostly _____ until later stages

Answer 11

CKD: GFR <60 for 3+ months
ESRD: CFR<15

Asymptomatic

Question 12

CKD can cause ____ magnesium, causing ….

Answer 12

LOW

Absent reflexes, low BP, decreased mental status, dysrhythmias

Question 13

CKD can cause metabolic ___-

Answer 13

Acidosis
-kussmaul

Question 14

CKD causes itchiness and uremic frost when….

Answer 14

Itchy: high phosphorus deposits in skin

Uremic frost: BUN >200

Question 15

How does CKD affect breath?

Answer 15

Uremic factor: urine smell

Question 16

If BP is taken on right arm and the hand/wrist contracts, what electrolyte imbalance is indicated?

Answer 16

Hypocalcemia
-trousseau sign

Question 17

What kind of foods contain lots of phosphate? Should these be supplemented or avoided in CKD diets?

Answer 17

Dark soda, chocolate, nuts, dairy, meats

-AVOID

Question 18

When is an organ transplant given?

Answer 18

If Hgb is < 11

Question 19

Stage 4 CKD diets usually involve ___, ___, ___ restriction

Answer 19

Na, K, Phos- based on lab results

Question 20

What daily weight gain should a CKD patient report?

Answer 20

> 2lbs/day