HYHO AKI

Question 1

What lab values indicate Acute Kidney Injury?

Answer 1

Increase in serum creatinine of > 0.3mg/dL within 48 hours or within 7 days OR urine output of <0.5mL/kg/hr for >6hrs

Question 2

Define Cardiorenal Syndrome

Answer 2

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

Question 3

What data is important in diagnosing Cardiorenal Syndrome?

Answer 3

• BUN/Creatinine levels
• Ejection Fraction (on Echocardiogram)
• BNP levels
• CXR

Question 4

Define anasarca

Answer 4

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

Question 5

The skin on the forehead of a dehydrated patient, when pinched, will remain elevated rather than springing back to its original position. This is known as?

Answer 5

Skin Tenting

Question 6

What is a positive fluid test, and what does it show.

Answer 6

-Fluid wave detects large volumes of free intrabdominal fluid. It has a specificity of 80-90%; a positive finding rules in ascites.

Question 7

Where are the Kidney Chapman Points

Answer 7

Anterior: One inch lateral and one inch superior to the umbilicus

Posterior: between the transverse process of T12 and L1

Question 8

In a 5 Model Approach to treating AKI, what is the Biomechanical aspect of the treatment?

Answer 8

Diagnosing
 SD of OA, AA
 SD of thoracic spine at viscerosomatic levels (T10-11)
 SD of the psoas muscles

Question 9

In a 5 Model Approach to treating AKI, what is the Respiratory/Circulatory aspect of the treatment?

Answer 9

 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

Question 10

In a 5 Model Approach to treating AKI, what is the Neurologic aspect of the treatment?

Answer 10

Kidney
o Sympathetics: T10-11
o Parasympathetic – vagus nerve
 Ureters – upper
o Sympathetics: T10-11
o Parasympathetics: vagus nerve
 Ureters – lower
o Sympathetics: T12-L2
o Parasympathetics: pelvic splanchnic nerve
 Bladder
o Sympathetics: T12-L2
o Parasympathetics: pelvic splanchnic nerve
o Kidney Chapman Points
 Rib raising treatment

Question 11

In a 5 Model Approach to treating AKI, what is the Metabolic/Energetic/Immune aspect of the treatment?

Answer 11

 Loop diuretics
 Fluid restriction
 Remove offending agents like NSAIDs, PPI
 Adjust meds based on renal function
 Monitor I/O’s, weights

Question 12

In a 5 Model Approach to treating AKI, what is the Behavioral aspect of the treatment?

Answer 12

 Exercise
 Diet – restrict fluids
 Avoid offending agents
 Better management of CHF (inciting cause)

Question 13

Long-term management of AKI consists of?

Answer 13

1. Discussion with patient regarding personal wishes regarding Dialysis, as well as other end of life matters such as Living Will and DPAHC
2. Avoid nephrotoxic drugs, including OTC preparations such as NSAIDs, PPI, etc
3. Regular monitoring of electrolytes, patient weight, fluid status, etc.

Question 14

List the initial treatment steps for AKI.

Answer 14

1. Remove offending agents: NSAIDS, PPI, etc.
2. Judicious use of loop diuretics (furosemide)
3. Adjust medication dosing based on renal function
4. Supportive care: oxygen
5. Monitor weight, I’s & O’s
6. Fluid restriction
7. Monitor electrolytes (Na+
   , K
   +
   , Ca+
   , Mg+
   , etc.)
8. Case management/manager
9. Dietary consult

Question 15

Why is a Living Will (LW) or Durable Power of Attorney for Healthcare (DPAHC) important in the care of a patient?

Answer 15

-Living Will: summarizes choices about future medical care; typically addresses resuscitation and life support, but may include other preferences about treatments (feeding tube, dialysis,
intubation/ventilator support).

-Durable Power of Attorney for Healthcare (DPAHC) authorizes another person (or surrogate) to make decisions on the patient’s behalf.

Question 16

How many stages exist in the KDIGO criteria for Acute Kidney Injury?

Answer 16

3.

-Stage 1 indicates risk of AKI, whereas Stage 3 indicates kidney failure

Question 17

What criteria are use in KDIGO to differentiate between stages?

Answer 17

Changes in the increase of serum creatinine, change in urine output, and initiation of RRT for Stage 3