Chapter 34: AKI and CKD Flashcards
Acute Renal Injury
decreased GFR, decreased waster removal, inability to egulate fluid, electrolytes, and pH balance
Azotemia
increased blood concentration of nitrogenous wastes (urea, nitrogen, uric acid and creatinine)
Prerenal AKI
associated with decreased renal blood flow
most common type
Causes of Prerenal AKI
hypovolemia dehydration burns distributive shock (sepsis, anaphylaxis) HF and cardiogenic shock post-MI renal stenosis
Intrarenal AKI
associated with renal ischemia, toxins or tubular obstruction
Causes of Intrarenal AKI
acute tubular necrosis
exogenous nephrotoxins (aminoglycosides, heavy metals, ethylene glycol)
endogenous nephrotoxins (myoglobin, uric acid, Hgb)
inflammatory conditions
Acute Tubular Necrosis
death of epithelial cells that line the renal tubules
once dead, the cells are released into the tubular lumen causing obstruction
Postrenal AKI
associated with the obstruction of urine outflow out of the kidneys
Causes of Postrenal AKI
ureteral calculi ureteral strictures bladder tumors spinal cord injuries BPH
Prerenal BUN:Cr
BUN:Cr ratio is higher than normal (>20:1)
urine has high osmolality (low Na)
Intrarenal BUN:Cr
BUN: Cr ratio is lower lower than normal (<10:1)
urine has low osmolality (urine Na high)
Onset of Acute Renal Failure
increased urinary excretion of Na = hyponatremia
Chronic Kidney Disease
slow, progressive inability of the kidneys to respond to changes in body fluids and electrolyte composition w/ an inability of the kidneys to produce sufficient urine
________ is essential in those with advanced kidney disease.
Restriction of protein
Uremia
term used to describe the clinical manifestations of CKD
Cardiovascular Sequela of CKD
HTN and CHF
accelerates atherosclerosis
Hematologic Sequela of CKD
anemia
hemolysis
coagulopathies = inc risk for thrombosis
Musculoskeletal Sequela of CKD
Bone breakdown
hyperphosphatemia = hypocalcemia
decreased vitamin D activation
Neurologic Sequela of CKD
uremic encephalopathy (dec LOC, delirium, coma)
peripheral neuropathy
unsteady gait
aterixis
GI Sequela of CKD
anorexia, N/V
metallic taste in mouth
GI mucosal bleeding
Endocrine Sequela of CKD
insulin resistance
reduction in sex hormones = dec ovulation, reduced libido, and impotence
Immune Sequela of CKD
suppression of the immune response
Integumentary Sequela of CKD
pale, dry skin
pruritus
may seen urea crystals precipitate on the skin
