HYHO AKI Flashcards
What is the definition/parameters of Acute Kidney Injury?
Acute Kidney Injury: Increase in serum creatinine of ≥ 0.3 mg/dL within 48 hours or within 7 days OR urine output of < 0.5mL/kg/hour for > 6 hours.
What is cardiorenal syndrome?
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. There is a bidirectional interaction between the heart and kidneys
Why is using creatine levels to calculate GFR slightly misleading in elderly populations?
-GFR is calculated using creatinine, which may underestimate the degree of dysfunction. For example, a frail elderly person has lower muscle mass therefore may have renal insufficiency with normal or only mild elevation of creatinine
What are the symptoms & signs associated with Acute Kidney Injury (AKI)?
decreased urine output
- worsening dyspnea including dyspnea at rest, orthopnea and/or paroxysmal nocturnal dyspnea (PND)
- worsening edema moving from dependent edema to anasarca and/or ascites
- tachycardia, S3,
- hypotension
- JVD
- liver distention and/or tenderness with palpation
- Distended abdomen: fluid wave, and/or puddle sign to assess for ascites
- skin tenting is best evaluated by pinching the skin of the forehead. The skin of a dehydrated patient will remain elevated rather than springing back to it’s original position.
What does a fluid wave detect?
-Fluid wave detects large volumes of free intrabdominal fluid. It has a specificity of 80-90%; a positive finding rules in ascites. However, its sensitivity is ~50%, so a negative test does not exclude ascites (i.e. it is volume dependent).
How does one perform a fluid wave?
The patient places the ulnar surface of their hand along the abdominal vertical midline. The operator places one hand on one flank and taps gently on the opposite flank. A positive sign when the operator feels a moderate to strong fluid wave emanating into the contralateral side.
What is a puddle sign?
-Puddle sign: It has a sensitivity of ~40 – 50% especially with small amounts of ascites. Positioning the patient makes it very difficult to evaluate.
This is an auscultatory percussion sign that requires the patient to support themselves on their hands and knees for 5 minutes. The operator then listens with the diaphragm while flicking a finger over a localized flank area of the abdomen starting at the lowest point and moving over to the opposite flank. A positive sign is when there is a sudden increase in intensity and clarity of the sound, signaling that the stethoscope has passed the edge of the peritoneal fluid.
What is anasarca?
-Anasarca is severe generalized edema that extends from the lower extremity proximally. It can cause ascites as well as subcutaneous edema; associated with heart failure, cirrhosis, severe malnutrition and renal failure.
What is paroxysmal nocturnal dyspnea?
-PND describes episodes of sudden dyspnea and orthopnea that awaken patient from sleep, prompting the patient to sit up or stand up. There may be associated wheezing and coughing. PND may be mimicked by nocturnal asthma attacks.
What is the sympathetic and parasympathetic innervation to the kidney and upper ureters?
Kidney Sympathetics: T10-11 Parasympathetic – vagus nerve Ureters – upper Sympathetics: T10-11 Parasympathetics: vagus nerve
What is the sympathetic and parasympathetic innervation to the bladder and lower ureters?
Ureters – lower
o Sympathetics: T12-L2
o Parasympathetics: pelvic splanchnic nerve
Bladder
o Sympathetics: T12-L2
o Parasympathetics: pelvic splanchnic nerve
What are the chapmans points of the kidney?
Chapman Points
o 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)
As part of the 5 Model Approach, what would the biomechanical approach be to a patient with AKI?
5 Model Approach Biomechanical: SD of OA, AA SD of thoracic spine at viscerosomatic levels (T10-11) SD of the psoas muscles
As part of the 5 Model Approach, what would the respiratory/circulatory approach be to a patient with AKI?
5 Model Approach
Respiratory/Circulatory
O2 via mask/nasal canula
-Lymphatics
o Thoracic inlet MFR
o Diaphragms (thoracolumbar, pelvic)
o Thoracic area: pectoral traction, doming the diaphragm, thoracic pump
o Abdominal area: abdominal pump, sacral rocking, pelvic diaphragm
o Extremities: effleurage, petrissage, pedal pump
o Rib raising
As part of the 5 Model Approach, what would the Metabolic/Energetic/Immune approach be to a patient with AKI?
Metabolic/Energetic/Immune Loop diuretics Fluid restriction Remove offending agents like NSAIDs, PPI Adjust meds based on renal function Monitor I/O’s, weights
