CIS 1 Flashcards
acute kidney injury definition
increase in serum creatinine +/- decrease in urine output over hours to days
effects of acute kidney injury
electrolyte disturbance
acid base disturbances (metabolic acidosis
inability to excrete nitrogenous waste
intravascular volume overload
less than 1% fractional excretion of sodium means what
the tubules are intact and sodium is being avidly reabsorbed, see this in dehyrdration, prerenal problem
sodium fractional excretion of over 1-2%
tuular function is not in tact
prerenal azotemia
etiology bun/cr UNa FeNa(%) urine osmolality urinary sediment
etiology: poor renal perfusion
bun/cr: >20/1
UNa: 500
urinary sediment: benign or hyaline casts
postrenal azotemia
etiology bun/cr UNa FeNa(%) urine osmolality urinary sediment
etiology: obstruction of urinary tract bun/cr: >20:1 UNa: variable FeNa(%): variable urine osmolality
BUN/creatinine in AKI
elevation in serum Cr by 50% or by 0.5-1.0 mg/dL
BUN elevated due to retetnion of nitrogenous wastes
-elevated bun = azotemia
elevated bun plus confusion = uremia
treatment for prerenal
fluid replacement IV
intrinsic renal failure
renovascular obstruction: renal artery obstruction can be pre renal or intrinsic renal
disase of glomeruli or microvasculature: accelerated HTN
acute tubular necorisis
interstitial nephritis:
intratubular deposition and obstruction: myeloma
renal allograft rejection
casues of interstitial nephritis
acute pyelonephritis, NSAIDs, contrast dye induced, drugs
what would cause a UNI-lateral hydronephrosis
postrenal block
1) ureteric: calculi, blood clot, sloughed papilla, cancer, tumor, fibrosis
2) bladder neck: neurogenic bladder, prostatic hypertrophy, calculi, cancer, blood clot
3) urethra: stricture, congenital valve, himosis
if AKI unresponsive to conservative measures consider temp hemodialysis in following
volume overload refractory to diuretics hyperkalemia encephalopathy pericarditis, pleuritis severe metabolic acidosis comporising resp or circulatory fnct
CKD
long standing, irreversible impariment of renal function
uremia: clinical syndrome resulting from profound loss of renal function
hyperkalemia and polystyrene resin
use when there is life threatening hyperkalemia
- when dialysis is not available, and other therapies have failed
- contraindicated in pts with risk factors for colonic necrosis
hyperkalemia: need to shift K+ into cell quickly
give IV glucose/insulin
give bicarb
give albuterol
