Kidney 4 Flashcards
is acute kidney injury (AKI) reversible
often yet if treated right
Rapid reduction in renal function (days)
Reduction of creatinine clearance by 50%
Increase of 0.5 mg/dl over baseline creatinine
Increase of 50% over baseline creatinine
Acute renal failure
what stage is Acute Kidney Injury if there is an increase in SCr by 2.0-2.9 x BL
or 12 hours
Stage 2 AKI
what stage is Acute Kidney Injury if there is an increase in SCr by 1.5-1.0x BL or >0.3mg/dL Or
<0.5 ml/kg/h x 6-12 hours
Stage 1 AKI
what stage is Acute Kidney Injury if there is an increase in SCr by 3.0x BL or incrase SCr to 4.0 mg/dl or initiation of RRT (dialysis)
12 hours
Stage 3 AKI
an increase in what for SCr is considered acute renal failure?
2.5
what drugs cause decreased proximal tubular secretion. This will increase SCr because they compete w/ creatinine to get out of the body.
Cimetidine
Triamterene
trimethoprim
what substances causes analytical interference w/ plasma creatinine
ketones
cephalosporins
methanol
isopropylalcohol
what cause increased BUN?
Increased protein intake Amino acid infusions GI bleed Catabolic states Steriods Tetracyclines
ARF caused by sudden and severe drop in BP or interruption of blood flow
prerenal ARF
what type of ARF is due to obstruction of urine flow due to englarged prostate, kidney stones, bladder tumor or injury
post renal ARF
what type of ARF is due to direct damage to the kidneys by inflammation, toxins, drugs, infection or reduced blood supply
intrarenal ARF
best non-invasvie test for renal anatomy
US
what causes most acute kidney injury
prerenal injury
what are brown casts indicative of?
acute kidney injury
tubular necrosis
what is an osmotic challenge?
diabetes
what causes most acute kidney injury
iatrogenic (something that is being done to the patient)
what drugs can cause acute kidney injury
aminoglycosides ACEI ARB NSAIDs radiocontrast cyclosporin cisplatin diuretics tacrolimus heme pigments
what can be used to prevent acute kidney injury due to contrast?
fluids diuretics (give after) mannitol acetylcysteine bicarbonate
if some one is one what drugs should you use caution when using contrast?
ACEI ARB NSAID diuretics (should be off of these meds for 24-48 hours before giving contrast if elective procedure)
what can cause interstitial nephritis
allergic rxn to drugs autoimmune dz (lupus) infiltrative dz (sarcoidosis) infectious process (legionaries)
if someone presents w/ mild proteinuria, sterile pyruia (don’t grow on cultures), polyuria and nocturia, osinophiluria, RTA, fanconi-like syndrome (glycosuria, phosphaturia, aminoaciduria)
tubule interstitial nephritis
what is the most common cause of post-renal acute kidney injury
prostatic hypertrophy
what drugs are associated w/ stone formation
Sulfonamides (not as common now) Methotrexate Acyclovir Triamterene Ethylene glycol Protease inhibitors - indinavir
what anti-naseau medication causes the least amount of potential outflow obstruction
meclizine
what are nephrotoxic risk factors
>70 years diabetic nephropathy low CO reduced renal funciton concurrent dz/ meds electrolyte/ acid/base abnormalities dose/osmolality/ time of exposure
safest and best way to assess kidneys with acute injury
US
most people with pre-renal failure will generally have what type of specific gravity
high
won’t be spilling Na
BUN: Cr will be >20
if someone has an obstruction w/ a uric acid crystal what can be done?
Na bicarb will dissolve the stones
what can form w/ phosphate crystals
staghorn calculi
sulfa crystals are associated w/ what?
sniffing pain/ glue
renal replacement therapy (dialysis) is only used for acute renal failure and what?
Uremic encephalopathy Uremic neuroirritability (asterixis) Refractory hyperkalemia Refractory acidosis Refractory volume overload Uremic pericarditis Certain ingestions
what stage of CKD Is a GFR is 30-59
CKD stage 3
what stage of CKD Is a GFR is 60-89
CKD stage 2
what stage of CKD Is a GFR is 15-29
CKD stage 4
what stage of CKD Is a GFR is >90
CKD stage 1
what is CKD if GFR is <15
CKD stage 5
what are common meds to use for CKD
Vit D analogues EPO phosphate binders Iron Sodium bicarb cinacalcet kayexalate
what are phostphate binders
calcium carbonate, calcium acetate, calcium citrate, lanthanum carbonate, sevelamer
most common cause of end-stage renal dz?
Diabetes melltis
what are routes for dialysis access?
Internal jugular cath
AV-fistula (BEST)
AV-graft
what causes most mortality in ESRD?
cardiac dz
