Diseases Flashcards
Defined as a sudden decline in kidney function causing disturbances in fluid, electrolytes and acid-base balance due to a loss of small solute clearance and
decreased GFR
acute kidney injury
Increased mortality even if renal function returns to normal**
AKI is defined as
Reduction of renal function within 48 hrs as defined by:
Absolute increase in serum creatinine > or equal to 0.3 mg/dl
Percentage increase in serum creatinine > or equal to 50%
Reduction in urinary output, with documented oliguria of less than 0.5 ml/kg per hour for more than 6 hours
stages of AKI
Stage 1-Inc. in Serum Cr >.3 or 150-200% from baseline, along with oliguria for
>6 hrs
Stage 2-Inc. in Serum Cr 200-300% from baseline, along with oliguria for >12 hrs
Stage 3-Inc. in Serum Cr >300% from baseline, need for RRT, and/or oliguria for 24 hrs/anuria > 12 hrs
An adaptive response to severe volume depletion and hypotension, with structurally intact nephrons
**Most common form of AKI, accounts for 55% AKI
pre-renal
what can cause prerenal failure
- volume depletion
- decreased CO
- arteriole vasoconstriction
- systemic vasodilation
M/C caused by acute tubular injury (ATN), either ischemic or cytotoxic
intrinsic
what can cause intrinsic renal failure
- drugs
- vascular
- AI
- tubular
Mechanical obstruction of urinary collecting system resulting in obstructive uropathy
postrenal
S/S chronic renal failure
fatigue, weight loss, anorexia, nocturia, and pruritis
acute tubular necrosis casts
granular, muddy brown
epitheleal
glomerulonephritis casts
RBC, tea colored
prerenal failure will have a FENa of
< 1%
how to tx AKI
volume expansion
decrease potassium intake, insulin & glucose, albuterol, kayexelate, lasix, IV calcium (cardiac instability)
when is dialysis indicated
volume expansion that cannot be controlled by diuretics Hyperkalemia refractory to medication
Severe acid-base imbalances refractory to medication Severe azotemia (BUN > 80-100), uremia,
Seizure/coma
CC <10 and serum Cr >9
how long after AKI is a pt dx with chronic renal failure
no improvement after 6-8 weeks