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CLIN MED3: GU/Renal > AKI, CKD, and Dialysis > Flashcards

AKI, CKD, and Dialysis Flashcards

1
Q

What is another name for acute kidney injury

A

Acute renal failure but AKI preferred

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2
Q

What does AKI increase your risk of

A

mortality 5x
progression to CKD

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3
Q

how do you define AKI

A

acute reduction in function (GFR, UOP) and accumulation of nitrogenous wastes (BUN/creatinine)

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4
Q

what are the three different formal definitions of AKI

A

acute dialysis quality improvement initiative (ADQI) RIFLE scheme
Acute Kidney injury Network definition (AKIN)
Acute kidney injury working group of KDIGO

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5
Q

what does ADQI stand for

A

acute dialysis quality improvement

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6
Q

what does AKIN stand for

A

acute kidney injury netrowk

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7
Q

what does KDIGO stand for

A

kidney disease: improving global outcomes

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8
Q

What is RIFLE criteria

A

Risk
injury
failure
loss
ESRD
changes must be within 7 days

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9
Q

what is AKIN criteria

A

exclude easily reversible causes first
make sure adequately resuscitated
changes in 48 hours

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10
Q

What are the diagnostic criteria for AKI with KDIGO

A

increase in SCr by 0.3+ mg/dL within 48 hours
increases in SCr 1.5+ times baseline, known or presumed in last 7 days
urine volume less than 0.5 mL/kg/h for 6 hours

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11
Q

what are the three types of AKI

A

pre-renal
intra-renal
post-renal

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12
Q

what is pre-renal AKI

A

most common
hypoperfusion: low volume, bad pump, vasodilation, intra-renal vasoconstruction

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13
Q

what is intra-renal AKI

A

85% due to ATN: ischemic, nephrotoxic
glomerulonephritis

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14
Q

what is post-renal AKI

A

obstruction

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15
Q

What is ATN

A

Acute Tubular Necrosis
aka acute renal tubular necrosis

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16
Q

what is the number one cause of intra-renal aki

A

acute tubular necrosis

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17
Q

what can cause acute tubular necorsis

A

ischemic
infection
nephrotoxins

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18
Q

what is the presentation of AKI

A

many asymptomatic
may have encephalopathy
may have bleeding/anemia
may have normal or abnormal urine output (UOP)

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19
Q

what antibiotics are nephtrotoxic

A

AG abx (aminoglycosides)
amp B
sulfa, acyclovir
tenofovir, vanco
etc.

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20
Q

what is oliguria

A

< 400mL/day

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21
Q

what is anuria

A

< 100 mL/day

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22
Q

What labs are ordered with concerns for AKI

A

CBC
CMP
Urinalysis: sodium osmolality, specific gravity, microscopic exam, FENa

23
Q

if urine sodium is <20 what is the likely cause of AKI

A

pre-renal

24
Q

what is the urine sodium level for AKI with intra-renal cause

A

> 40

25
Q

What is FENa

A

Fractional excretion of sodium
helps to differentiate between pre-renal and intrarenal (ATN)
*need urine and blood

26
Q

what is a FENa of < 1%

A

pre-renal cause

27
Q

what is a FENa of >2%

A

intra-renal cause

28
Q

what is the UOP with pre-renal AKI

A

decreased because less volume

29
Q

what is the first line imagine for AKI

A

renal ultrasound
looks for obstruction

30
Q

when is renal biopsy indicated

A

if pre- and post-renal causes and ATN is excluded

31
Q

what is the treatment of AKI

A

supportive: avoid additional injury, maintain perfusion/volume, +/- renal replacement therapy (RRT)
Prevention (KDIGO reccomendations)

32
Q

What is CKD

A

chronic kidney disease

33
Q

what are risk factors for CKD

A

hypertension
DM
small birth weight
childhood obesity
hx immune d/o
increasing age
black race
+fhx
structural/anatomic abnormalities

34
Q

what manifests as gradual decline in kidney function weeks to years

A

CKD

35
Q

how do we measure the decrease in kidney function

A

GFR

36
Q

What is the presentation of CKD

A

early on, asymptomatic (stage 1 and 2)
Stage 3-4 +/- vague symptoms: HTN, anemia, fatigue, decreased appetite, malnutrition, electrolyte abnormalities
Stage 5 (ESRD) worsening nutrition, electrolyte and mineral disturbances

37
Q

what is uremic syndrome

A

symptoms due to accumulations of nitrogenous waste

38
Q

what are symptoms of uremic syndromes

A

fatigue
anorexia
nausea
metallic taste
irritability, insomnia
memory impairment
restless leg, paresthesias, muscle twitching
puruitis
decreased libido, menstrual changes
asterixis, myoclonus

39
Q

What is the hallmark lab for CKD

A

persistent reduced GFR > 3 months

40
Q

what is the study of choice for CKD

A

renal US

41
Q

how do we manage CKD

A

goal is to limit progression
good control of DM
good BP control
good control of cholesterol
achieve and maintain healthy DMI
optimize CVD risk factors
maintain healthy diet
dose adjust meds as needed
avoid nephrotoxins

42
Q

What is the mainstay of treatment for ESRD

A

renal replacement therapy (RRT)
hemofiltration, hemodialysis, peritoneal dialysis

43
Q

what is the definitive treatment of CKD

A

renal transplant

44
Q

what are complications of CKD

A

1 cause of mortality in CKD is CVD

#1 complication of VCD is HTN
metabolic bone disease
anemia
coagulopathy
hyperglycemia

45
Q

What is RRT

A

techniques that ‘replace’ the filtration of the dysfucntional kidneys

46
Q

What does RRT include

A

hemofiltration
hemodialysis: continuous, intermittent
peritoneal hemodialysis

47
Q

What is the most common RRT modality

A

intermittent hemodialysis

48
Q

when is continuous hemodialysis used

A

AKI and unstable patients

49
Q

Who gets RRT

A

fluid overload unresponsive to diuretics
hyperkalemia, hypercalcemia and metabolic acidosis unresponsive to treatment
uremia
GFR <10 if no DM; GRF < 15 in DM
certain toxins

50
Q

What are the two processes of RRT

A

Diffusion and oconvection

51
Q

what is diffusion RRT

A

movement of particles down a concentration gradient

52
Q

what is convection RRT

A

movement of particles AND WATER down a pressure gradient (hydrostatic pressure)

53
Q

what does dialysis remove (solutes)

A

Na+, Cl-, K+, HCO3-, Ca2+, Mg2+, urea, creatinine, uric acid

54
Q
A

CLIN MED3: GU/Renal (11 decks)

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