F&E= Acute Kidney Injury Flashcards
What happens during the diuretic stage of acute kidney injury?
- urine output exceeds 400 mL/day; may rise above 4 L/day
2. kidneys excrete BUN, creat, K+, and phosphorus and retain Ca and Bicarb
What happens during the recovery stage of acute kidney injury?
- as renal tissue recovers, serum electrolytes, BUN, and creat. return to normal
- This stage lasts 1-12 months
What can acute renal failure manifest itself as?
Metabolic acidosis
What are the causes of prerenal failure?
- hypovolemia (hemorrhage, dehydration, excess fluid loss from GI tract, burns, wounds)
- low cardiac output (HF, Cardiogenic shock)
- altered vascular resistance (Sepsis, anaphylaxis, vasoactive drugs)
What are the causes of intrarenal failure (within the kidney)?
- Glomerular/microvascular injury
- Acute tubular necrosis
- interstitial nephritis
What causes postrenal failure?
- Obsructions beyond the kidneys which causes urine to back up into the nephrons (BPH, Renal calculi, tumors)
Is acute renal failure more common in older adults or younger adults?
younger adults
What goal should you have for someone with postrenal failure?
Maintain blood flow and urine output
What are some causes of inadequate blood flow to the kidneys?
- heartattack
- infection
- severe allergic reaction
- damage
- inflammation in the glomerulus
- lupus
Is AKI a rapid change or gradual change in kidney function?
Rapid
How can acute tubular necrosis occur?
Caused by prolonged ischemia (lack of blood flow to the kidneys) lasting more than 2 hours
Who are at risk for developing Acute Tubular Necrosis?
- prolonged surger
- hypovolemia
- sepsis
- burns
- trauma
- NSAIDs
- chemo
- people around heavy metals (mercury, gold)
- exposure to chemicals such as antifreeze
True or false: Acute Tubular Necrosis causes prerenal failure?
False: Acute Tubular Necrosis causes intrarenal failure becuase it damages the nephrons.
What will children with AKI most likely experience as a manifestation?
Oliguria (Decreased urine output)
What drug is especially nephrotoxic for children?
Ibuprofen and acetaminophen
What are some risk factors for AKI?
- major trauma or surger
- infection
- hemorrhage
- HF
- liver disease
- Lower urinary tract obstruction
What age group is at a higher risk for kidney failure?
Older adults because of their higher indicidences of serious illness, hypotension, major surgeries, diagnostic procedures, and treatment with nephrotoxic drugs.
Children with what disorder are more at risk for AKI?
- Renal insufficiency (decrease in ability to conserve sodium and concentrate the urine)
- Acute GI illness (risk for dehydration)
What is the third most common cause of hospital-aquired AKI?
Contrast -induced nephropathy
What are the three phases of AKI?
Initiation, maintenance, and recovery
How long does the initiation of AKI last?
hours to days
When does the initiation phase of AKI begin?
It begins with the initiating event (Such as a hemorrhage) and ends when tubular injury occurs
True or false: the initiation phase of AKI is asymptomatic
True
What characterizes the maintenance phase of AKI?
A significant fall in GFR and tubular necrosis with possible oliguria
What happens during the maintenance phase of AKI?
- edema (increases risk for HF and Pulmonary Edema)
- Hyperkalemia
- Hyperphosphatemia
- Hypocalcemia
- metabolic acidosis
Give some more manifestations of maintenance phase
- confusion, disorientation, agitation, or lethargy; hyperreflexia; and possible seizures or coma because of azotemia and electrolyte and acid-base imbalances
- Anorexia (loss of appetite), nausea, vomiting, and decreased of absent bowel sounds
- Uremic syndrome (if AKI is prolonged)
What is the recovery phase of AKI characterized by?
A process of tubule cell repair eand regeneration and gradual return of the GFR to normal or pre-AKI levels
What are the manifestations of the recovery phase of AKI?
Diuresis (abnormally large quantities of urine), serum creatinine, BUN, potassium, and phosphate levels reain high and may continue to rise in spite of increasing urine output.
What are the goals of treatment for AKI?
- maintain the fluid and electrolyte balance
- identify and correcting the underlying cause
- preventing additional kidney damage
- restoring the urine output and kidney function
- compensating for renal impairment until kidney function is restored
Meds for AKI
- IV fluids and vlood volume expanders
- Dopamine (increases renal blood flow)
- loop diuretics, osmotic diuretics
- ACE inhibitors to lower BP
- electrolyte supplements
- Kayelxalate (removes potassium from the body)
