Exam 3: Renal Failure (Acute Renal Failure/Acute Kidney Injury) Flashcards
What is the general definition of acute kidney failure?
Rapid reduction in kidney function. Within hours or days.
What shit gets fucked up when you have acute kidney failure?
→ Fluid and electrolyte balance
→ Acid-Base balance
→ Unable to get rid of toxins
What is azotemia?
Build up of nitrogenous waste
What is something that automatically puts you at high risk of going into acute kidney failure in the hospital?
Being in the hospital!
Reduced perfusion = ____________ failure.
PRERENAL
What are some causes of prerenal failure?
→ Shock
→ Hypotension
→ Anything that blocks blood flow to kidneys (Atherosclerosis)
Kidney damage = _________ failure.
INTRARENAL
What are some issues that can cause intrarenal failure?
→ Glomerulonephritis
→ Lupus
→ Drugs that damage to the kidney
→ Lupus
→ Toxins
→ Ischemia
What are just a few drugs that can cause damage to the kidneys?
→ IV contrast
→ Abx – Vanc!
→ NSAIDS
Obstruction = ___________ failure.
POSTRENAL
What are some causes of postrenal failure?
→ Bladder Cancer
→ Kidney Stones
→ Prostate cancer or BPH
Three ways kidneys compensate with AKF?
→ Activating RAAS system
→ Constricting kidney blood vessels
Raise pressure
→ Releasing ADH
Hold onto fluid → perfusion
All the ways kidneys compensate are grea! Do they increase/decrease blood volume?Increase/decrease kidney perfusion?
They also cause:
Increase, increase.
→ Oliguria
→ ADH causes less urination
→ → Azotemia (build-up of nitrogenous waste)
Oliguria =?
(how many ml/day)
Less than 400 mL/24 hours
Kidney failure is number one reason _______ patients die (name of disease)
Lupus
What is one of the big clues that there is AKI?
Oliguria
What lab value is one of the best indicators of AKI?
Creatinine
Per Iggy: The serum creatinine level does not increase until 50% of the kidney function is lost, so ANY level of serum creatinine values is important.
What is a normal BUN?
10 - 20
(Remember: This is measuring the effectiveness of kidney excretion of urea nitrogen, a by-product of protein breakdown in the liver)
What is a normal serum creatinine (Mary isn’t allowed to answer this)?
Normal < 1.2
You will see abnormal electrolytes with AKI. Will the K+ and Na be high or low?
High K+, high Na
If patients are still urinating, what is likely happening?
Filtration problem
What are some other diagnostic tests to confirm AKI?
→ Ultrasound
→ CT Scans (no IV contrast)
→ MRI
→ X-ray/ KUB (kidney, ureter, and bladder x-ray)
Name 3 early signs of AKI:
→ Low UOP (less than 30mL/hr)
→ Edema
→ Rising creatinine
What do we want to maintain our MAP at?
MAP > 65
If you are not seeing urine in the collection bag, what should you do?
Check the foley/line for kinks
What is one of the main meds we will use first when we confirm AKI?
Diuretics
Most people with AKI don’t get__________ and don’t even get a ______________.
Dialysis, renal consult
Acute kidney injury outcomes:
About __% of patients with AKI will not recover kidney function.
10%
What happens in end stage renal disease (general)?
→ Will require long term dialysis and/or transplant
→ Will require long term dialysis access
Your patient has a history of hypertension and is admitted for hypertensive crisis. He is on a nicardipine drip with parameters to keep the blood pressure below 180/100. Currently, your patient’s blood pressure is 96/58 and the drip is running at 25mg/hr. You notice that your patient’s urinary output is 80 mL over the last four hours. After reducing the rate of the nicardipine drip, what is your next priority action?
A) Check the patency of the foley catheter
B) Call rapid response
C) Call the provider
D) Give the patient a bolus of NS
A) Check the patency of the foley catheter
ALSO: Provider should have given bottom parameters – don’t be afraid to ask for them!
Why do we need to be careful with patients with HTN and AKI?
The patient lives at that high BP level. Then we give BP meds and they can’t perfuse (prerenal failure!)
Describe the basics of CKD (3):
→ Progressive
→ Irreversible
→ Leads to end stage kidney disease
What are the stages of CKD based on?
Glomerular Filtration Rate
What is a normal GFR?
125 ml/min totaling 180 L/day
Google says 90 to 120 mL/min/1.73 m2
Quick throwback question: How is GFR controlled in the body?
Per Iggy: By selectively constricting and dilating the afferent and efferent arterioles. When systolic pressure drops below 65 - 70 mm Hg, these self regulation processes do not maintain GFR.
What is the GFR for stage 1 CKD?
Normal GFR!
They just have an increased risk for kidney damage
Name 3 diseases that have this highest risk factors, thus are stage 1:
HTN, Lupus, DM
Describe stage 2 CKD. What is the GFR?
Mild disease/ decrease in kidney function/ mild decrease in GFR (60-89)
Describe stage 3 CKD. What is the GFR?
Moderate disease/Azotemia present/ Restriction of fluids/ GFR (30-59)
Describe stage 4 CKD. What is the GFR?
Severe disease/ cannot maintain A-B and F-E balance/ Dialysis may be needed/ GFR (15-29)
Describe stage 5 CKD. What is the GFR?
GFR < 15/ Dialysis or death/ Transplant?
At what stage do we begin treating CKD?
Stage 3
Re: Blood cells. What do kidneys contribute?
Help make red blood cells (erythropoietin!). When they are damaged this can cause anemia.
Once __% of function is gone, kidneys unable to maintain urine production and maintain homeostasis
75%
When a majority of the function is gone, what happens to the BUN and urine production (up? down?)?
→ BUN rises
→ Urine production decreases
With CKD do patients become acidotic or alkalotic? Why?
Acidotic. Acid excretion is decreased. NOT related to DKA.