AKI HYHO

Question 1

What is anasarca?

Answer 1

Severe generalized edema that extends from the lower extremity proximally. Can cause ascites as well as subcutaneous edema; associated with HF, cirrhosis, severe malnutrition, and renal failure.

Question 2

Kidney sympathetics and parasympathetics

Answer 2

S: T10-11
P: vagus nerve

Question 3

Ureters- upper sympathetics and parasympathetics

Answer 3

S: T10-11
P: vagus nerve

Question 4

Ureters- lower sympathetics and parasympathetics

Answer 4

S: T12-L2
P: pelvic splanchnic nerve

Question 5

Bladder sympathetics and parasympathetics

Answer 5

S: T12-L2
P: pelvic splanchnic nerve

Question 6

Chapman points kidney anterior

Answer 6

One inch lateral and one inch superior to the umbilicus

Question 7

Chapman points kidney posterior

Answer 7

Between the transverse process of T12 and L1 (on the ipsilateral side)

Question 8

5 model approach: biomechanical

Answer 8

SD of OA, AA
SD of T spine at viscerosomatic levels (T10-11)
SD of the psoas muscles

Question 9

5 model approach: respiratory/circulatory

Answer 9

O2 via mask/nasal canula

Lymphatics (thoracic inlet, diaphragms, rib raising)

Question 10

5 model approach: neurologic

Answer 10

Viscerosomatics and chapman’s points

Question 11

5 model approach: metabolic/energetic/immune

Answer 11

Loop diuretics
Fluid restriction
Remove offending agents like NSAIDs, PPI
Adjust meds based on renal function
Monitor I/Os, weights

Question 12

5 model approach: behavioral

Answer 12

Exercise
Diet-restrict fluids
Avoid offending agents
Better management of CHF (inciting cause)

Question 13

What is the main neurohumoral adaptation in the setting of AKI in conjunction with AHF?

Answer 13

In the setting of HF, hemodynamic derangements trigger activation of the sympathetic nervous system and RAAS, which increases release of ADH and endothelin-1. This promotes salt and water retention and systemic vasoconstriction.

Systemic vasoconstriction increases cardiac afterload which reduces cardiac output, which can further reduce renal perfusion.

Question 14

What are the stage 1 KDIGO criteria for AKI?

Answer 14

Increase in serum creatinine of >0.3 mg/dL within 48 hours of >50% within 7 days
OR
Urine output of <0.5 mL/kg/hour for >6 hours