AKI & CKD - patho - E2

Question 1

kidney functions (3+)

Answer 1

-maintain fluid & lytes
-ride body of water sol waste (lots of drugs)
-endocrine functions:
+produces erythropoietin
+activates vit D
+produces renin to help regulate BP

Question 2

what is the blood flow amount through the kidneys

Answer 2

1L per minutes (about 20% of CO)

Question 3

how to measure kidney function / kidney injury

Answer 3

GFR -> healthy is usually >90, ~60 indicates a problem, 25-30 = renal insufficiency

Question 4

AKI

Answer 4

the result of ischemic injury r/t loss of volume causing decreased perfusion -> think blood loss, third spacing or toxins build up
body tries to compensate w/ inflamm. process which ends up causing cell death

Question 5

3 classifications of AKI

Answer 5

1) pre renal: volume loss related
2) intra renal: acute tubular necrosis (chemical, kidney cell death -> DM)
3) post renal: not common, obstruction causing cell death

Question 6

AKI clinical manifestations (7)

Answer 6

-oliguria
-fluid vol loss
-metabolic acidosis
-hypoNa
-hyperK
-waste product accumulation
-neurologic disorders
usually begins 1 day after hypotension event & lasts 1-3 wks

Question 7

causes of hypotension

Answer 7

surgery, blood loss, dehydration

Question 8

treatment of AKI

Answer 8

treat the cause
- pre renal give fluids
- intra give antidote
- fix lyte imbalance

Question 9

CKD: stage 1

Answer 9

GFR: >90
Mani: asym
Plan: dx & treat + reduce CVD risk & try to slow progression

Question 10

CKD: stage 2

Answer 10

GFR: 60-89
Mani: asym, ~HTN
Plan: estimation of progression

Question 11

CKD: stage 3A

Answer 11

GFR: 45-59
Mani: HTN
Plan: eval & treat comps

Question 12

CKD: stage 3B

Answer 12

GFR: 30-44
Mani: HTN
Plan: more aggressive treatment

Question 13

CKD: stage 4

Answer 13

GFR: 15-29
Mani: dx happens here bc sx present
Plan: prep for renal replacement therapy

Question 14

CKD: stage 5

Answer 14

GFR: <15
Mani: uremic
Plan: renal replacement

Question 15

risk factors for CKD (8)

Answer 15

-family hx
-increasing age (>60)
-male
-black
-HTN, DM, smoking (+ HLD/CAD)
-overweight

Question 16

CKD pathogenesis (bad summary kinda ignoring)

Answer 16

starts with renal injury ischemia / volume loss and then causes a lot of things but when we see evidence of proteins in the urine and increase angiotensin 2 (a powerful vasoconstrictor) -> these are the biggest signs of worsening CKD
+also some inflammation caused by leaky protein
Cyclical problem, monitor urine & BP

Question 17

CKD clincial manifestations

Answer 17

every body system affected, look at slide + amped up inflammation
big ones:
-HNT, heart failure & diseases
-anorexia, N/V, GI bleeding
-fatigue, HA, sleep probs, encephalopathy
-skin probs
pulm edema is a really bad sign

Question 18

CKD mani based off of kidneys no longer being able to main F & E homeostasis

Answer 18

edema, hyperK, hyperPhos, hyperMg, metabolic acidosis

Question 19

CKD mani based off of kidneys no longer ridding the body of waste via urine

Answer 19

anorexia, malnutrition, itching, CNS changes

Question 20

CKD mani based off of decreased production of erythropoietin

Answer 20

anemia (hgb of 5 or 6)

Question 21

CKD mani based off of decreased activation of vit D

Answer 21

renal osteodystrophy & weakened bones that are easily breakable