Exam 3 - AKI and CKD Flashcards
what is the function of the kidney
- maintain fluid and electrolyte homeostasis
- rid the body of water-soluble wastes via urine
what are three important endocrine functions
- produces erythropoietin: stimulates RBC production
- activates Vitamin D
- produces renin, which helps regulate blood pressure
what is AKI usually the result of
- ischemic injury related to loss of volume -> decreased perfusion
- toxins or sepsis are also common causes
pre-renal
volume loss related
intra-renal
- acute tubular necrosis
- chemical, kidney cell death
post-renal
- not as common, obstruction causing cell death
AKI: clinical manifestations
- oliguria (< 400ml/24hr)
- begins 1 day after hypotensive event and lasts 1-3 weeks
- fluid volume excess
- metabolic acidosis
- hyponatremia
- hyperkalemia
- waste product accumulation
- neurologic disorders
risk factors for CKD
- family history
- increasing age (>60)
- male
- African American
- HTN, DM, smoking
- overweight and obesity
CKD manifestations
- cardiovascular
- gastrointestinal
- neurologic
- pulmonary
- integumentary
what happens when kidneys no longer maintain F & E homeostasis
- edema
- hyperkalemia
- hyperphosphatemia
- hypermagnesemia
- metabolic acidosis
what happens when the kidneys no longer rid the body of waste via urine
- anorexia
- malnutrition
- itching
- CNS changes
what happens with decreased production of erythropoietin
- anemia
what happens with decreased activation of Vitamin D
- renal osteodystrophy
what can CKD drugs be used for
- slow the rate of progression of CKD
- treat the complications of CKD
slow the rate of progression of CKD
- reduce BP to less than 140/90
- treat hyperlipidemia (cholesterol of less than 200, may be placed on a statin)
treat the complications of CKD
- volume overload
- hyperkalemia
- metabolic acidosis
- hyperphosphatemia
- renal osteodystrophy
- anemia
BP control for CKD
- ACE or ARB
- other BP meds as needed to maintain SBP (110-130)
- lipid control, statins as needed
what is given for volume overload
- loop diuretic (furosemide)
- used with low-salt diet
what is given for hyperkalemia
- multiple
- address with hemodialysis in ESRD
what is given for metabolic acidosis
- sodium bicarbonate
- an alkaline agent
what is given for hyperphosphatemia
- calcium carbonate
- a phosphate binder
what is given for renal osteodystrophy
- calcitriol
- activated vitamin D
what is given for anemia
- erythropoietin
- black box warning!
what is sodium bicarbonate used to treat
metabolic acidosis
