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ANSTZ > B.1 > Flashcards

B.1 Flashcards

1
Q

characteristics of AKI

A
  • sudden loss of renal function –> decrease GFR within hrs/days)
    –>increase createnine
    –>increase BUN
  • decrease urine output –> oliguria
  • Acid-Base disturbances
  • electrolytes disturbances
  • impaired urinary execretion of drugs
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2
Q

Etiology of AKI

A
  • prerenal: most common (decrease renal perfusion)
  • Renal: Glomerular, Tubular, Interstitia, Vascular
  • PostRenal: obstruction
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3
Q

PreRenal pathophys. background

A
  • shock
  • IAH
  • RA thrombosis
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4
Q

Renal pathophys. background

A
  • Glomerulonephritis
  • pyelonephritis
  • vasculitis
  • nephrotoxins
  • HTN
  • Amyloidosis
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5
Q

PostRenal pathophys background

A
  • BPH
  • malignancy
  • stones
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6
Q

consiquences of AKI?
(10)

A

volume overload
metabolic acidosis
electrolytes
pulmonary edema
acute lung injury
uremia
immune system
hematological
GI edema
pharmacological

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7
Q

consiquences of AKI related to VOLUME?

A
  • CHF
  • HTN
  • decreased perfusion
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8
Q

consiquences of AKI related to metabolic acidosis?

A
  • Hypercholermia
  • Accumulation of organic ions (PO4)
  • decrease Albumin –> buffer
  • impaired insulin action –> hyperglycemia
  • catecholamine resistance
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9
Q

consiquences of AKI related to electrolyte disturbances?

A
  • hyperkalemia
  • hyponatremia
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10
Q

consiquences of AKI related to pulmonary edema?

A

due to low albumin

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11
Q

consiquences of AKI related to uremia?

A

decreased GFR

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12
Q

consiquences of AKI related to immune syst?

A
  • ROS clearance decreased
  • WBC function decrease
  • infection risk increase|
  • T.edema
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13
Q

consiquences of AKI related to Hematological?

A
  • decrease EPO –> anemia
  • decreased vWF –> bleeding
  • increased RBC destruction
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14
Q

consiquences of AKI related to GI edema?

A
  • compartment syndrome
  • decreased nutritional absorption
  • gut ischemia

ALL lead to –> peptic ulcer

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15
Q

consiquences of AKI related to pharmacological?

A

decreased bioavailability
decreased elemination
decreased albumin

all lead to –> under-dosing or toxicity

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16
Q

AKI in ICU?

A

25-70% AKI

15-60% increased mortality

no causual therapy but replacement therapy is possible

17
Q

how do you diagnose AKI?

A

physical signs:
- decrease BP
- decrease turgor
- tachycardia
- edema: if HF and cirrhosis

Lab:
- decrease URINE Na <20mmol/L
- increase urine osmolarity > 500mOsm/L
- increase urine specific gravity > 1020
- increase urea in serum –> BUN>creatinine
- neg. urinary sediment

18
Q

RIFLE criteria in AKI?

A

Risk
Injury
Failure
Loss of function
ESRD (end stage renal disease)

19
Q

what are the I criteria in AKI?

A

I= injury

  • createnine criteria: 2-9x baseline
  • Urine output: < 0.5ml/kg/hr for >12h
20
Q

what are the R criteria in AKI?

A

R = at risk

  • createnine criteria: 1.5-1.9x increase in createnine within 7 days
  • Urine output: < 0.5ml/kg/hr for 6-12h
21
Q

what RIFLE criteria is based on?

A
  • acute increase in serum createnine
  • acute decrease in Renal output
22
Q

what are the F criteria in AKI?

A

F= failure

  • createnine criteria: 3x baseline
  • Urine output: < 0.3ml/kg/hr for >24h or Anuria for 12hr
23
Q

what is the L criteria in AKI

A

L= loss of function

complete loss of renal function >4w

24
Q

supportive AKI management?
avoidance

A
  • nephrotoxic
  • contrast studies
25
Q

supportive AKI management?
perfusion optimization

A

Hgb, O2, MAP

  • IV fluids, crystalloids
  • vassopressors
26
Q

supportive AKI management?
pharmacological

A

dobutamine:
-increase GFR
-increase Na-water excretion
-increase diuresis

manittol

ANP,BNP:
-dilate aff
-constricts eff
=>incr. GFR

Loop dieretix:
- increase flow rate
- decrease Na-resorption
- decrease eneregy expendature

N-Acetylcysteine
-antioxidant

27
Q

supportive AKI management?
nutritional therapy

A
  • normoglycemia
  • protein supply
  • ulcer prophylaxis
28
Q

symptomatic AKI management>

A
  • correction of acid-base
  • correction of electrolytes
  • diuretix
  • RRT
29
Q

RRT Definition?

A

used for patients in ICU with renal failure to remove excess of fluid or to clear the blood from toxins (urea/K)

30
Q

what the RTT clearance depends on?

A
  • blood flow
  • dialysate
  • dialyzer
31
Q

what is the dialysate solution made of?

A

isotonic fluid:
- electrolytes
- HCO3/acetate
- glucose

32
Q

what is the flow rate in RRT?

A

countercurrent flow of dialysate through dialyzer
the higher the flow rates the greater the clearance via diffusion

33
Q

mechanisms involved in RTT?

A

diffusion: with dialysis –> clears small molecules

convection: with UF –> clears small and medium molecules

34
Q

what is CVVHF?

A

Conintuous Veno-Veno
HemoFiltration

35
Q

what is CVVHD?

A

Conintuous Veno-Veno
HemoDialysis

36
Q

what is CVVHDF?

A

Conintuous Veno-Veno
HemoDiaFiltration

ANSTZ (7 decks)

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