E2 326 AKI & CKD - patho Flashcards
kidney functions (3+)
-maintain fluid & electrolytes
-rid body of water sol waste (lots of drugs)
-endocrine functions:
+produces erythropoietin
+activates vit D
+produces renin to help regulate BP
what is the blood flow amount through the kidneys
1L per minutes (about 20% of CO)
how to measure kidney function / kidney injury
GFR -> healthy is usually >90, ~60 indicates a problem, 25-30 = renal insufficiency
AKI
the result of ischemic injury r/t loss of volume causing decreased perfusion -> think blood loss, third spacing or toxins build up
body tries to compensate w/ inflamm. process which ends up causing cell death
3 classifications of AKI
1) pre renal: volume loss related
2) intra renal: acute tubular necrosis (chemical, kidney cell death -> DM)
3) post renal: not common, obstruction causing cell death
AKI clinical manifestations (7)
-oliguria
-fluid vol loss
-metabolic acidosis
-hypoNa
-hyperK
-waste product accumulation
-neurologic disorders
usually begins 1 day after hypotension event & lasts 1-3 wks
causes of hypotension
surgery, blood loss, dehydration
treatment of AKI
treat the cause
- pre renal give fluids
- intra give antidote
- fix electrolyte imbalance
CKD: stage 1
GFR: >90
Mani: asymptomatic
Plan: dx & treat + reduce CVD risk & try to slow progression
CKD: stage 2
GFR: 60-89
Mani: asym, ~HTN
Plan: estimation of progression
CKD: stage 3A
GFR: 45-59
Mani: HTN
Plan: eval & treat comps
CKD: stage 3B
GFR: 30-44
Mani: HTN
Plan: more aggressive treatment
CKD: stage 4
GFR: 15-29
Mani: dx happens here bc sx present
Plan: prep for renal replacement therapy
CKD: stage 5
GFR: <15
Mani: uremic
Plan: renal replacement
risk factors for CKD (8)
-family hx
-increasing age (>60)
-male
-black
-HTN, DM, smoking (+ HLD/CAD)
-overweight
CKD pathogenesis (Summary)
starts with renal injury ischemia / volume loss & then causes a lot of things but when we see evidence of proteins in the urine & increase angiotensin 2 (a powerful vasoconstrictor) -> these are the biggest signs of worsening CKD
+also some inflammation caused by leaky protein
Cyclical problem, monitor urine & BP
CKD clincial manifestations
every body system affected, look at slide + amped up inflammation
big ones:
-HNT, heart failure & diseases
-anorexia, N/V, GI bleeding
-fatigue, HA, sleep probs, encephalopathy
-skin probs
pulm edema is a really bad sign
CKD manifest based off of kidneys no longer being able to main F & E homeostasis
edema, hyperK, hyperPhos, hyperMg, metabolic acidosis
CKD manifest based off of kidneys no longer ridding the body of waste via urine
anorexia, malnutrition, itching, CNS changes
CKD manifest based off of decreased production of erythropoietin
anemia (hgb of 5 or 6)
CKD manifest based off of decreased activation of vit D
renal osteodystrophy & weakened bones that are easily breakable
