HYHO AKI Flashcards
Clinically, what defines AKI?
increase in serum creatine of > .3mg/dL within 48hrs or within 7 days
OR
urine ouput of < 0.5mL/kg/hour for > 6 hours
What is it called when treatment for HF is limited by a decline in renal function? How is this decline noticed?
Cardiorenal syndrome is a condition in which therapy to relieve congestive symptoms of HF is limited by a decline in renal function as manifested by reduction in GFR.
Pre-renal azotemia is more common in what pts?
HF
(BUN/Cr > 20)
*30-60% of HF pts develop severe kidney probs
What phyiscal changes of the kidneys are seen in CKD?
- decrease size
- cortical thinning
(others include cystic kidneys –> look for underlying disease)
What can be used to rule out obstructive cause of KI?
US –> +/- hydropnephrosis
(if -, rules out obstruction)
What should you expect of urine Na+ levels in HF pts? Why?
- <25meg/L
- due to reduced renal perfusion –> inc RAAS/SNS –> promote Na+ retention
*urine Na+ inc with diuretics
What are causes of prerenal AKI?

What are the causes of intrinsic AKI?

What are causes of postrenal AKI?

When I say ___, you think:
a. Blue toes
b. ‘Drug Rash’
c. Volume contraction
d. Volume overload/HF
e. Jaundice/ascites
a. cholesterol emboli
b. acute interstitial nephritis
c. dehydration
d. cardiorenal syndrome
e. liver disease with portal HTN
What are common sx of AKI?
- oliguria
- edema (dependent –> anasarca –> ascites)
- dyspnea (orthopnea, PND, rest)
- tachycardia (S3)
- JVD
- hypotension
- liver distenstion/tenderness
- distended abdomen (+puddle sign)
- skin tenting
What is the best way to measure skin tenting?
- pinching skin of the forehead
- if dehydrated, skin will remain elevated
What can mimic PND?
nocturnal asthma attacks
What is anasarca?
- severe generalized edema that extends from LE proximally
- can cause ascites and subcutaneous edema
*associated with HF, cirrhosis, severe malnutrition, RF
How is a fluid wave test performed? what does it tell us?
a. pt. places ulnar surface of their hand along midline; operator places one hand on one flank and taps gently on the opposite flank –> + when the operator feels a moderate to strong fluid wave emanating into the contralateral side
b. if +, rules in ascites; if -, cannot rule out ascites
Describe a puddle sign

What are the sympathetic/parasympathetic levels of the kidney?
S: T10-11
P: vagus n.
What are the sympathetic/parasympathetic levels of the ureters upper? lower?
upper: S - T10-11; P - vagus n.
lower: S - T12-L2; P - pelvic splanchnic n.
What are the sympathetic/parasympathetic levels of the bladder?
S - T12-L2
P - pelvic splanchnic n.
What are the ant/post chapman points of the kidney?
- Anterior: one inch lateral and one inch superior to the umbilicus
- Posterior: between the transverse process of T12 and L1 (on the ipsilateral side)
What is included in the biomechanical approach of AKI?
- SD of OA, AA
- SD of thoracic spine at viscerosomatic levels (T10-11)
- SD of the psoas muscles
What is included in the lymphatic approach of AKI?
- O2 via mask/nasal canula
- Lymphatics
o Thoracic inlet MFR
o Diaphragms (thoracolumbar, pelvic)
o Thoracic area: pectoral traction, doming the diaphragm, thoracic pumpo Abdominal area: abdominal pump, sacral rocking, pelvic diaphragm
o Extremities: effleurage, petrissage, pedal pump
o Rib raising
What is included in the neurologic approach of AKI?
all the related sympathetics/parasympathetics/chapmans points and rib raising
What is included in metabolic/energetic/immune approach?
- Loop diuretics
- Fluid restriction
- Remove offending agents like NSAIDs, PPI
- Adjust meds based on renal function
- Monitor I/O’s, weights



