Kidney 5 Flashcards
With prerenal injury, there is __________, but there is no ________
inadequate perfusion of the kidneys but not intrinsic damage
Treatment for prerenal injury includes
restoration of renal blood flow with IVF
hemodynamic support
& PRBCs
Intrinsic injury can be caused by injury of the
tubules, glomerulus or interstitial space
Causes of acute tubular necrosis include
ischemia and nephrotoxic drgus
Treatment of intrinsic injury is
supportive
The source of obstruction for postrenal injury can arise anywhere between
the collecting duct and the urethra
Treatment of postrenal injury is
to remove the obstruction
___________ does not prevent or treat AKI
renal dose dopamine
Attempting to convert oliguric to nonoliguric AKI with ______ increases the risk of additional renal injury as well as mortality
diuretics
The following patients are at risk for AKI during the perioperative period:
pre-existing kidney disease
sepsis
jaundice
prolonged renal hypoperfusion
CHF
advanced age
high-risk surgery (use of aortic cross clamp & liver transplant)
What is the RIFLE criteria?
risk
injury
failure
loss
end-stage kidney disease
Risk indicates
increased SCr to >1.5x baseline
UOP <0.5 mL/kg/hr for >6 hours
Injury indicates
increase in Scr to >2x baseline
UOP <0.5 mL/kg/hr for >12 hours
Failure indicates
increase in SCr to >3x baseline or increase >0.5 mg/dL to absolute value of >4 mg/dL
UOP <0.3 mL/kg/hr >12 or anuria >12 hr
Loss indicates
need for renal replacement therapy >4 weeks
End-stage indicates
need for renal replacement therapy >3 months
Prerenal injury can be a result of
intravascular volume depletion
decreased CO
systemic vasodilation
renal vasoconstriction
increased abdominal pressure
Intrinsic injury can be a result of
tubular injury
tubulointerstitial injury
glomerular injury
renal vasculature
large vessels
The risk of prerenal azotemia is reduced by
maintaining MAP >65 mmHg and providing appropriate hydration
The use of _________ is associated with an increased risk of renal morbidity
hydroxyetyl starches
In healthy patients, ________ can reduce renal blood flow
alpha-1 agonists
__________ preferentially constricts the efferent arteriole. It maintains GFR and UOP better than norepinephrine or phenylephrine
Vasopressin
What are the 3 classification schemas for AKI?
RIFLE
AKIN
KDIGO
Pathophysiologic considerations for the end-stage renal disease include: (select 3)
a. secondary hyperparathyroidism
b. increased prothrombin time
c. megaloblastic anemia
d. obstructive ventilatory defect
e. gap metabolic acidosis
f. increased bleeding time
a. secondary hyperparathyroidism
e. gap metabolic acidosis
f. increased bleeding time
Chronic kidney disease is a
progressive and irreversible disorder that reflects the ongoing inability of the kidneys to sustain their normal functions
The most common cause of CKD is
diabetes mellitus
The second most common cause is
hypertension
Complications of CKD include
uremic syndrome
uremic bleeding
anemia
HTN
CHF
CAD
gap metabolic acidosis
hyperkalemia
osteodystrophy
restrictive ventilatory defect
peripheral neuropathy
autonomic dysfunction
infection
_________ is the cornerstone of CKD treatment
dialysis
Indications of dialysis include
volume overload
hyperkalemia
severe metabolic acidosis
symptomatic uremia
overdose with a drug that is cleared by dialysis
____________ is the most common event during dialysis
Hypotension
How many stages of CKD are there?
5
S/sx of uremic syndrome include
anemia
fatigue
N/V
anorexia
coagulopathy
The first line treatment for uremic bleeding is
desmopressin
With uremic bleeding _________ is normal & _____________ is higher
PT, pTT, and platelet counts; bleeding time
Treatment of anemia includes
exogenous EPO or darbepoetin + iron supplementation
EPO can cause
hypertension
The most common cause of death for CKD patients is
CAD- assume all patients with CKD have CAD
Five indications for the use of dialysis include
volume overload
hyperkalemia
severe metabolic acidosis
symptomatic uremia
overdose with a drug that is cleared by dialysis
_________ is the leading cause of death in dialysis patients
Infection
Stage 1, normal, GFR is
> 90 mL/min
Stage 2, mildly decreased, GFR is
60-89 mL/min
Stage 3, moderately decreased GFR is
30-59 mL/min
Stage 4, severely decreased, GFR is
15-29 mL/min
Stage 5, kidney failure, GFR is
<15 mL/min
Why does anemia occur in patients with chronic renal failure?
decreased production of erythropoietin leads to normochromic normocytic anemia
What leads to a gap metabolic acidosis in chronic renal failure?
decreased excretion of non-volatile acids
Dialysis is indicated when serum potassium exceeds
6 mEq/L
