Kidney Disease Flashcards
KDIGO criteria for RISK of AKI
Increased SCr 1.5-1.9 x baseline OR >/= 0.3 mg/dl increase in 48 hrs
KDIGO criteria for INJURY of AKI
2.0-2.9x baseline or GFR decrease > 50%
KDIGO criteria for Failure of AKI
3.0x baseline SCr OR Increase in SCr >/= 4 mg/dl OR Initiation of renal replacement therapy
Normal GFR is ~ what per min?
120-125 mL
GFR is regulated intrinsically:
Afferent arteriole constriction occurs in response to what?
Afferent arteriole dilation occurs in response to what?
+/- vasoconstriction in response to what?
vasc smooth muscle stretch in HTN
Vasc smooth muscle relaxation in hypotension
NaCl concentrations
Passive process for urine production involves what?
hydrostatic pressure pushes fluid & solute thru membranes
Proximal Convoluted tubule is responsible for?
most absorptive capability
reabsorbs all glucose, AA, 65% of Na & H20
Nephron loop is responsible for what:
Descending loop?
Ascending loop?
reabsorbs water
Na, K, Cl, Ca, Mg reabsorption
Distal Convoluted tubule is responsible for what?
Na transport; aldosterone regulation
Tubular secretion disposes substances
In acidotic states what does the Distal convoluted tubule dispose of?
drugs
metabolites
urea
uric acid
excess K
Creatinine
NH4
H+
In alkalotic states what does the distal convoluted tubule do?
Cl reabsorption occurs as bicarb acid is excreted
Selected causes of AKI requiring Immediate diagnosis and specific therapies
Decreased Kidney Perfusion
Volume status and urinary diagnostic indices
Selected causes of AKI requiring Immediate diagnosis and specific therapies
Acute glomerulonephritis, vasculitis, interstitial nephritis, thrombotic microangiopathy
Urine sediment examination
serologic testing
hematologic testing
Selected causes of AKI requiring Immediate diagnosis and specific therapies
UTI
Kidney US
Causes of AKI
Exposures
Sepsis
Critical Illness
Circulatory Shock
Burns
Trauma
Cardiac Surgery
Major noncardiac surgery
nephrotoxic drugs
radiocontrast agents
poisonous plants and animals
Causes of AKI
Susceptibilities
Dehydration or volume depletion
advanced age
female gender
black race
CKD
Chronic diseases (heart, liver, lung)
DM
CA
Anemia
Prerenal causes of AKI
Hypovolemia
Impaired Cardiac Function
Systemic Vasodilation
Increased Vascular resistance
Intrinsic Causes of AKI
Tubular
Glomerular
Interstitium
Vascular
Postrenal Causes of AKI
Extrarenal Obstruction
Intrarenal Obstruction
Prevention and Management of AKI
What type of fluids to use?
Use what during shock?
Use of what to maintain a blood glucose between what?
If AKI is present achieve a total energy intake of how much?
How much protein in non-catabolic AKI w/o RRT?
How much protein if on RRT? up to how much on CRRT or hyper-catabolic state?
Isotonic crystalloids > colloids for volume expansion (unless bleeding)
Vasopressors + fluids
Insulin for BG 110-149 mg/dL
20-30kcal/kg/d
0.8-1g/kg/d
1-1.5g/kg/d; 1.7g/kg/d
Prevention and Management of AKI
Type of nutrition?
Avoid what to prevent AKI?
When to use diuretics with AKI?
Avoid low dose what to prevent or tx AKI?
Avoid what abx if possible?
enteral > parenteral
diuretics
AKI with volume overload only
dopamine
aminoglycosides
Risk Factors for Contrast-Induced AKI include
pre-existing renal dysfunction
DM
HTN
CHF
advanced age
Volume depletion
HD instability
Large volume/high osmolality of contrast
nephrotoxic med agents
Risk of Contrast-Induced AKI can be as high as 25% if what is present?
pre-existing renal dysfunction
OR
CKD + DM, CHF, advanced age, or nephrotoxic meds
Prophylaxis prior to contrast administration is recommended for patients who have AKI or an eGFR < 30 mL/min who are not undergoing maintenance dialysis. What is the recommended prophylaxis?
Prophylaxis should be considered for patients with an eGFR of what?
IV NS
30-44 mL/min
Clinical Evaluation
History
Meds - prescribed, OTC, Herbals, recreational
Social - exposure to tropical diseases (malaria), water, sewage, rodents (leptospirosis, hantavirus)
Clinical Evaluation
PE
Fluid status
Acute/chronic heart failure
Infection/sepsis
+/- CO, preload responsiveness
Intra-abdominal pressure
Clinical Evaluation
Labs
BMP
CBC
UA with micro (cells, casts, crystals, bacteria)
urine chemistries (Na, creatinine, urea)
Clinical Evaluation
Imaging
US
Furosemide Stress Test
when to do it?
how much to give?
Monitor UO for how long?
Predicted progressive AKI for UO of how much?
Stage 1 or Stage 2 AKI
1mg/kg IV furosemide
2 hrs
< 200cc
AKI Definition
Increase in SCr by 50% w/n 7 days OR increase in SCr by 0.3mg/dl w/n 2 days OR oliguria
CKD definition
GFR < 60 ml/min for > 3 mo
AKD definition
Alterations in kidney function & structure that do not meet criteria for either AKI or CKD, yet may need medical attention to restore kidney function & reverse damage
NKD definition
GFR >/= 60 ml/min and Stable SCr
Life-threatening Indications for RRT
Hyperkalemia
Acidemia
Pulmonary Edema
Uremic Complications
Nonemergent indications for RRT
Solute Control
Fluid removal
Correction of acid-base abnormalities
