AKI and CKD Exam 2 Flashcards
Kidney Functions
Main fluid and electrolyte homeostasis
Rid the body of water-sulable wastes via urine
3 important endocrine functions
Kidney: Three important endocrine functions
Produce erythropoietin - stimulates RBC production
Activates Vitamin D
Produces renin, which helps regulate blood pressure
Why is kidney injury such a large problem?
Kidneys are NEEDY
Renal blood flow = 1 L per min = 20% CO
Kidney injury can be sudden and rapidly progress (can take a hit and happen in hours)
BUT: Can be reversible
Renal insufficiency
90 ml/hr is normal GFR in healthy
25% of normal GFR 25-30 ml/hr indicates Renal insufficiency
What is indicator of kidney injury
GFR <90 but GFR is not always indicator of acute kidney injury
3 Classifications of AKI
Based on where the injury is occuring
Pre-renal
Intrarenal
Post-renal
Pre-Renal AKI
Do you volume loss. Hypotension or hypovolemia
Intrarenal AKI
Acute tubular necrosis. This happens within the kidney. Drug overdose.
DM and HTN
Post Renal AKI
Not as common. Obstruction causing cell death. BPH
AKI: Clinical Manifestations
Oliguria = <400 ml/24 hr period
Fluid volume excess
Metabolic acidosis
Hyponatremia
Hyperkalemia
Waste product accumulation
Neurologic disorders
AKI happens
1 day after hypotensive event and can last 1-3 weeks
Chronic Kidney Disease: 6 stages
The stages are determined by GFR in mL/min
Stage one and two = No symptoms
Moderates stages = Hypertension
Severes stages = Other clinical manifestations (stage 5 = Uremic)
Best way to treat chronic kidney disease
Prevent by controlling the things that cause it
Most common caused of CKD
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
CKD: Pathogenesis
PP slide
What indicates worsening chronic kidney disease
Increase in angiotensin II
Proteinuria
Watch blood pressure and monitor urine of these patients
CKD Manifestations
Neurologic
Cardiovascular
Gastrointestinal
Integumentary
Cardiovascular Manifestation of CKD
HTN
CAD
Pericarditis
PAD
Neurological Manifestations of CKD
Fatigue
Headache
Sleep disturbances
Encephalopathy
Gastrointestinal Manifestations of CKD
Anorexia
Nausea
Vomiting
GI bleed
Gastritis
CKD: Manifestations: No longer maintains F & E Homestostatis
Edema (third spacing) (FVO)
Hyperkalemia
Hyperphosphatemia
Hypermagnesemia
Metabolic acidosis
CKD manifestations: No longer rids the body of wastes via urine
Anorexia (lack of appetite)
Malnutrition
Itching (frost)
CNS changes
CKD manifestations: Decreased erythropoietin
anemia
CKD Manifestations: Decreased activations of Vitamin D
Renal osteodystrophy
Drugs can be used for
Slowing the rate of progression of CKD
-Reduces BP to less than 140/90
-Treat hyperlipidemia (cholesterol less than 200)
Treating all the complications of CKD
Slowing the progression of CKD: Blood pressure control
ACE or ARB
Other BP meds as needed to maintain SBP (110-130)
Slowing the progression of CKD: Lipid control
statins as needed
Complications of CKD: Volume overload treatment
Loop diuretic (Furosemide)
use with low salt diet
Complications of CKD: Hyperkalemia
Multiple (Diuretic) (Kayexalate) (Dialysis)
Addressed with hemodialysis in ESRD
Complications of CKD: Metabolic acidosis treatment
Sodium bicarbonate (lower PH)
An alkaline agent
Complications of CKD Treatment hyperphosphatemia
Calcium carbonate (will lower phosphate levels)
Phosphate binder
Complications of CKD Renal osteodystrophy treatment
Calcitriol
Activated vitamin D
Complications of CKD Anemia treatment
Erythropoietin
BBW
Complications of drug therapy
Many drugs are excreted through the kidneys
Drug doses and frequency may be adjusted
