AKI- CKD- ESRD

Question 1

Anemia of CKD

Answer 1

• Decreased Epo production- significant at stage 3
• Iron deficiency- must have adequate stores
• Tx with erythropoiesis stimulating agents

Question 2

Coagulopathy of CKD

Answer 2

• Due to platelet dysfxn
• Prolonged bleeding time
• Sx: petechiae, purpura
• Tx: symptomatic pts- Raise Hb levels

Question 3

Slowing progression of CKD

Answer 3

• Tx underlying cause: DM, HTN, lose wt
• HTN = most modifiable risk factor
• Diet: protein, water, salt, K+ & phosphorus intake
• Early ID = better
• Correct CV risk factors
• Males, blacks worse outcomes
• Adjust meds to GFR
• Prevent AKIs

Question 4

Hemodialysis

Answer 4

• 60% ESRD pts
• AV fistula preferred- surgical construction
• Tx at center 3x/ week, 3-5 hrs
• Can be done at home or at night

Question 5

Peritoneal dialysis

Answer 5

• 10% ESRD pts
• Peritoneal membrane = dialyzer
• Dialysate instilled into peritoneal cavity, equilibrate and drained
• Continuous ambulatory: exchange 4-6 x per day
• Continous cyclical: cycler automatically performs at night
• Peritonitis

Question 6

Renal transplant

Answer 6

• 50% ESRD healthy enough for surgery
• 2/3 from deceased
• Long wait list- 2-6 yrs
• High survival rates
• Immunosuppressants to prevent rejection
• 30% ESRD pts get one

Question 7

Acute kidney injury

Answer 7

• Sudden decrease in kidney fxn- inablilty to maintain acid-base, fluid, lytes balance & nitrogenous wastes
• Defined as risk, injury & failure based on serum creatinine levels

Question 8

AKI- Prerenal

Answer 8

• Most common (40-80%)
• Decreased renal perfusion due to:
• Reduced intravascular volume
• Change in vascular resistance: blockers
• Low CO:

Question 9

AKI- Prerenal- Reduced Intravascular volume- Eti

Answer 9

hemorrhage, dehydration, pancreatitis, burn, trauma

Question 10

AKI- Prerenal- Change in vascular resistance- Eti

Answer 10

sepsis, anaphylaxis, anesthesia, renin-angiotensin-aldosterone

Question 11

AKI- Prerenal- Low cardiac output- Eti

Answer 11

Cardiogenic shock, HF, PE, pericardial tamponade

Question 12

AKI- Postrenal

Answer 12

• Least common- 5-10%
• Obstruction, bladder dysfxn
• Anuric or polyuric with lower abd pain
• High urine osmolality
• Catheterization & US
• Backup of waste products causes elevated intralumial pressure- parenchymal damage

Question 13

AKI- Intrinsic

Answer 13

• Injury to tubules, interstitium, vasculature and glomeruli

- Tubular necrosis, acute interstitial nephritis, rapidly progressive glomerulonephritis

Question 14

Azotemia

Answer 14

Retention of nitrogenous waste and creatinine in blood- due to AKI or CKD. Measured by BUN: creatinine ratio

Question 15

Uremia

Answer 15

• Blood in urine
• Significant if found on more than 2 occasions
• Can be renal or extrarenal