Beth - Week 12 - Exam 4 Flashcards
review: what does the kidney do?
◦ Excretion ◦ Filter ◦ Controls BP ◦ Regulate RBC production ◦ Metabolizes drugs and hormones ◦ Synthesizes Vit D ◦ Manages electrolytes - Ca++ balance ◦ Glucose homeostasis ◦ Balances pH
how is acute kidney injury defined?
- defined as a rapid loss of kidney function
- identified as increase in serum creatinine or ↓ urine output
what are the three characteristics of the pathophysiology of acute kidney injury?
- the degree of dysfunction depends on the early ID and interventions of the healthcare team
- AKI can be multifactorial
AKI is characterized as ____, ____, and ____
- prerenal
- intrarenal
- postrenal
what is the currrent data base of AKI defined?
- severity, duration, and outcome is complicated with both oliguria and relapses in AKI
- stage 3 AKI and AKI that has persisted over 7 days or more
what is the onset, cause, diagnostics, reversibility, and cause of death of AKI?
- sudden
- acute tubular necrosis
- acute drop in UO and ↑ creatinine
- potential reversibility
- infection and sepsis
what is the onset, cause, diagnostics, reversibility, and cause of death of CKD?
- gradual over years
- diabetic nephropathy
- GFR <60mL for 3 mo
- progressive, irreversible
- results in CV death
what is azotemia (early AKI)?
excessive nitrogenous waste in the blood - Urea - Creatinine ◦ 3 stages - Pre-renal - Intra-renal - Post-renal
what is oliguria?
Reduction of UO less than w400ml/day
what is uremia/uremic (late - CKD)?
◦ “urine in the blood” Raised level nitrogenous waste in
the blood
- Urea
- Creatinine
how does AKI start?
sudden episode
- can be hours to days
what are the risk factors of AKI?
decreased perfusion to the kidney
- hypotension
- hemorrhage
- dehydration
- acute MI
- liver failure
- burns (massive fluid loss)
- injury (trauma)
- major surgery
what are the direct causes of AKI?
- toxins (ATB)***test
- sepsis ***test
- multiple myeloma
- interstitial nephritis
- glomerulonephritis
- urinary obstruction (kidney stones, blood clots in urinary tract,
for direct causes of AKI, what are the specific toxins that can cause AKI?
- ANTIBIOTICS (vanco, aminoglycosides, amphotericin B, cephalosporins)
- OTHER DRUGS (diuretics, NSAIDs, contrast, chemo, illicit drugs)
- HEAVY METALS (lead, mercury, copper)
- ORGANIC SOLVENTS (glycol, gas, kerosene, turpentine)
- POISONS (mushrooms, insecticides
what are the three condition that predispose a person to AKI (can cause CKF)?
- prerenal
- intrarenal
- postrenal
TEST:how does prerenal conditions cause AKI?
- hypoperfusion
- low renal blood flow to the kidney, prevent BP going to kidneys
- outside the kidney*
TEST: what are the causes of prerenal condition?
hemorrhage, dehydration
• dehydration - burns, loss of large volumes via GI
• ↓ vascular filling - shock and sepsis
• HF - cardiogenic shock, low C.O. MI, CHF
• anaphylaxis
TEST: what are the findings for someone in a prerenal condition?
- oliguria
- labs: ↑ BUN, ↑ Cr
read pre-renal example.
David, 68, lives alone. 5 days ago, he developed
a fever & began vomiting. He took sips of
ginger ale to settle his stomach. Today, his
neighbor finds him weak and feverish, so she
brings him to the ER. Davids B/P is 78/60 &
his U/O is 15ml after straight cath. His BUN is
72mg/dl & Creat is 1.6mg/dl— ANSWER TO
FOLLOW
answer to prerenal example
- Dehydration resulting in sever hypotension
(low blood volume to the kidneys) as noted
by BUN, sl. Creat; ¯ U/O; temp, emesis X
5days - Kidneys aren’t removing urea however the
slight elevation of creat indicates that his
nephrons haven’t been damaged - PLAN: antiemetic PRN; fluid replacement to
volume to renal bld. flow and reverse the
pre-renal condition
is the prerenal condition reversible?
REVERSIBLE!
what is an intrarenal condition?
AKI - acute tubular necrosis
- direct damage to kidney
- *damage to the renal tissue**
what are the causes of intrarenal condition?
- prolonged kidney ischemia
- examples: trauma to kidney, Nephrotoxic agents, contrast, hemolytic transfusion reaction, chemicals, intratublar obstruction, acute renal disease (acute glomerulonephritis/pyelonephritis)
what are the findings in a intrarenal condition?
- oliguria
- labs: ↑ BUN, Cr
TEST: read the example for intrarenal
Gloria, 58, was in a MVA—In OR she was
hypotensive for 55 mins. Due to a open
fractured femur, she was also started on
Vancomycin to prevent osteomyelitis. Her
BUN and Creat are trending upward and today,
her BUN is 55 mg/dl & Creat is 5.2mg/dl with
no urine output—ANSWER TO FOLLOW
TEST: answer to the intrarenal example
- ARF due to a nephrotoxic drug— Vancomycin and massive myglobinuria
from tissue damage - Damage to the nephrons ( Creat)
- PLAN: Hydrate kidney, stop the drug and
do a trough—renal doses of meds;
probable dialysis if no response - GOAL: control primary disease, treating
the ARF, preventing further injury and
promoting renal healing
