AKI & CKD

Question 1

Functions of the Kidneys (5)

Answer 1

Maintain fluid & electrolyte balance
Rid the body of water-soluble wastes
Produces erythropoietin- stimulates RBC production
Activates Vitamin D
Produces renin, which helps regulate blood pressure

Question 2

What is a normal GFR?

Answer 2

> 90 ml/hr

Question 3

What percentage of a normal GFR is considered renal insufficiency?

Answer 3

25% of normal GFR (25-30ml/hr)

Question 4

3 classifications of acute kidney injury

Answer 4

pre-renal
intrarenal
post-renal

Question 5

Pre-renal AKI is caused by

Answer 5

fluid volume loss (Ex: surgery, trauma, dehydration)

Question 6

Intrarenal AKI is caused by

Answer 6

acute tubular necrosis (Ex: drug overdose, toxic meds, kidney diseases, vascular issue - DMII, HTN)

Question 7

Post-renal AKI is caused by

Answer 7

obstruction causing cell death

Question 8

AKI Manifestations (8)

Answer 8

Oliguria
Begins 1 day after hypotensive event and last 1-3 weeks
Fluid volume excess (edema)
Metabolic acidosis
Hyponatremia
Hyperkalemia
Uremia - waste product accumulation
Neurological disorders

Question 9

Top 3 causes of End Stage Renal Disease

Answer 9

1. Diabetes (50%)
2. HTN (30%)
3. Glomerulonephritis (10%)

Question 10

CKD risk factors (8)

Answer 10

Family history
Increasing age (>60)
Male
Black/African American
Overweight/obesity
Hypertension
Diabetes Mellitus
Smoking

Question 11

Major signs of worsening kidney disease

Answer 11

Increasing Angiotensin II and Proteinuria

Question 12

CKD: Neurologic Manifestations (4)

Answer 12

Fatigue
Headache
Sleep disturbance
Encephalopathy (severe)

Question 13

CKD: Cardiovascular Manifestations (5)

Answer 13

HTN
Heart failure
Coronary artery disease (CAD)
Peripheral artery disease (PAD)
Pericarditis

Question 14

CKD: GI Manifestations (5)

Answer 14

Anorexia
Nausea
Vomiting
GI bleed
Gastritis

Question 15

CKD: Integument Manifestations (3)

Answer 15

Pruritus
Ecchymosis
Dry, scaly skin

Question 16

What CKD manifestation is a major sign that the patient needs to start dialysis

Answer 16

pulmonary edema

Question 17

Resulting Clinical Manifestations of No longer maintains F & E homeostasis (5)

Answer 17

Edema (third spacing) Hyperkalemia
Hyperphosphatemia Hypermagnesemia
Metabolic acidosis

Question 18

Resulting Clinical Manifestations of no longer rids the body of wastes via urine (4)

Answer 18

Anorexia
Malnutrition
Itching & other skin manifestations
CNS changes

Question 19

Resulting Clinical Manifestation of decreased production of erythropoietin (1)

Answer 19

Chronic anemia

Question 20

Resulting Clinical Manifestations of decreased activation of
Vitamin D (2)

Answer 20

Renal osteodystrophy
Weakened bones

Question 21

Pharmacotherapy for CKD aims to (2)

Answer 21

Slow the rate of CKD
Treat the complications of CKD

Question 22

Slowing the progression of CKD includes (2)

Answer 22

Blood pressure control (ACE or ARB)
Lipid control (Statins and diet control)

Question 23

Many drugs are excreted through the kidneys. What happens if drug elimination is decreased?

Answer 23

buildup, toxicity

Question 24

High risk drugs for AKI/CKD (4)

Answer 24

Digoxin
Diabetic agents (glyburide, metformin)
Antibiotics (Vancomycin)
Opioids (morphine)

Question 25

Treatment for fluid volume overload in CKD (2)

Answer 25

Loop diuretics (furosemide) Low salt diet

Question 26

Treatment for hyperkalemia in CKD (3)

Answer 26

Diuretics Kayexalate Hemodialysis

Question 27

Treatment for metabolic acidosis in CKD

Answer 27

sodium bicarbonate

Question 28

Treatment for hyperphosphatemia in CKD

Answer 28

calcium carbonate (Tums)

Question 29

Treatment for renal osteodystrophy in CKD

Answer 29

Calcitriol (activated vitamin D)

Question 30

Treatment for anemia in CKD

Answer 30

Erythropoietin (Epoetin alfa)

Question 31

Black Box Warning for Epoetin alfa

Answer 31

Increased risk of cardiovascular events and stroke (increased Hct = increased risk of clotting)