AKI and CKD Flashcards
AKI is defined as
increase in serum creatinine +/- decrease in urine output over hours to days
As a result of _ the following are some of the things affected electrolyte disturbances, acid-base disturbances (metabolic acidosis) inability to excrete nitrogenous waste and IV volume overload
AKI
_ can be caused by dehydration aka volume contraction or EC volume depletion, due to fluid losses from nausea and vomiting.
orthostatic hypotension
Poor tissue turgor can be due to _
volume deficit
If a patient presents to ER after passing out with no significant medical history, but history of nausea vomiting prior to this event indicating dehydration. Aside from UA, what additional labs is indicated to to determine possible causes?
Serum electrolytes, BUN and creatinine - need to determine Na, K, Cl levels that can be affected by dehydration. It’ll tell us if pt is retaining nitrogenous waste and retaining creatinine, indicating AKI
Fractional Excretion of sodium helps to sort between what two renal issues?
Pre-renal vs intrinsic renal issues.
If a patient is dehydrated, what would their specific gravity be?
high or on the higher end of normal. Normal is 1.003-1.040
how do you calculate FeNA?
(Una / Pna ) / (Ucr / Pcr) x 100
What does FeNa less than 1% indicate?
Tubules are intact and Na avid ie retaining sodium as would be expected in dehydration. Prerenal cause
Azotemia is defined as?
elevated BUN
An elevated Creatinine is implicated as
AKI
Elevated BUN plus confusion would be termed as _
uremia. Uremia is azotomia with symptoms.
Anything that compromises renal perfusion is indicated as pre-renal. What are some examples of prerenal issues?
- hypovolemia: dehydration, viral syndromes, acute pancreatitis, diuretics
- Low CO: CHF
- Altered renal/SVR ration: sepsis, cirrhosis
- Renal hypoperfusion with impaired autoregulation: NSAIDs
- Hyperviscosity syndrome (rare): myeloma
In many pre renal issues, such as hypovolemia due to dehydration, and even with effective volume depletion such as pancreatitis what treatment is indicated/
- Fluid replacement by IV.
- treat the underlying cause
What are 6 methods of intrinsic renal failure?
- renovascular obstruction : renal artery obstruction e.g. embolism, dissecting aortic aneurysm (renal a. stenosis etc)
- Disease of glomeruli or microvasculature as seen in accelerated HTN
- Acute tubular necrosis: iodinate contrast dye -
- Interstitial nephritis: acute pyelonephritis, NSD, contrast dye etc
- Intratubular deposition and obstruction: myeloma
- Renal allograft rejection
what two pre renal diseases greatly increase risk of tubular damage from contrast dye?
HTN and DM
if pan AKI patient is unresponsive to conservative measures, when would hemodialysis be indicated?
A. volume overload refractory to diuretics
B. Hyperkalemia
C. Encephalopathy otherwise unexplained
D. Pericarditis, pleuritis
E. severe metabolic acidosis compromising respiratory or circulatory function
the 5 stages of CKD is based on what measured value?
GFR
what are the 5 stages of CKD?
- kidney damage with normal or increased GFR (equal or greater than 90)
- Mild decrease in GFR (60-89)
- moderate decrease in GFR 30-59
- Severe decrease in GFR 15-29
- Kidney failure (ESRD) less than 15 or on dialysis
If a patient comes in with stage 2 CKD, no HTN or DM what is the best mode of treatment?
ACE inhibitor. It poses kidney protection to delay progression of CKD even if blood pressure does not need treatment. Follow patient every 3 months
what effects does uremic toxins have on cellular function?
Reduce in transmembrane voltage ( inc. Na, dec. K. Inhibit Ca influx)
- reversible with dialysis
what effects does uremic toxins have on whole body composition?
- osmoticaly induced overhyrdation of cells
- increased EC volume
- Malaise, anorexia, N/V/D ( protein and calorie malnutrition, negative nitrogen balance, profound loss of lean body mass and fat deposits)
What effects does uremic toxins have on metabolism?
- Hypothermia (decreased active Na transport)
- IC deficits of K
- Metabolic acidosis
what effects does Uremic toxins have on Nitrogen and lipids?
- Protein intolerance (increase catabolism and decrease elimination)
- hypertriglyceridemia, decrease HDL, normal cholesterol ( decrease removal by lipoprotein lipase, increase lipogenesis, and possibly increase production by liver and intestine
