Lect 1

Question 1

Anuria

Answer 1

less than 100 mL/day

Question 2

Oliguria

Answer 2

100-400 mL/day

Question 3

Non-oliguria

Answer 3

> 400 mL/day

Question 4

Non-oliguria

Answer 4

> 400 mL/ day

Question 5

high risk patients

Answer 5

preexisting renal insuffienciency, congestive HF, cirrhosis, diabetes, age, dehydration, nephrotoxic drugs, IV dye, critical illness

Question 6

what are some examples of nephrotoxic agents?

Answer 6

aminoglycosides, amphotericin B, cisplatin, carboplatin, IV contrast dye

Question 7

what agents have an impact on renal blood flow?

Answer 7

NSAID, ACE-I, cyclosporine, tacrolimus

Question 8

goal of volume expansion therapy

Answer 8

maintain urine output >150 mL/hr

Question 9

volume expansion

Answer 9

NS (preferred in critically ill): 1-1.5 mL/kg/hr 3-12 hours before and after IV contrast exposure
sodium bicarbonate: 3 mL/kg/hr for 1 hour prior and 1 mL/kg/hr for 6 hours after

Question 10

prevention of AKI with amphotericin B

Answer 10

lipid formulations preferred over conventional

Question 11

prevention of AKI with amphotericin B

Answer 11

lipid formulations preferred over conventional

Question 12

N-acetylcysteine (Mucomyst)

Answer 12

scavenges free oxygen radicals
as adjunct to IV isotonic crystalloids
expensive
600-1200 mg BID day before and day after IV contrast administration

Question 13

which are NOT recommended for prophylaxis?

Answer 13

theophylline, ascorbic acid, statins, fenoldopam (DA-1 agonist w/ risk of hypotension), dopamine, diuretics (mannitol and furosemide)

Question 14

insulin

Answer 14

may have direct protective effect (decrease in development of ARF)
Target glucose 110-149 mg/dL

Question 15

insulin

Answer 15

may have direct protective effect (decrease in development of ARF)
Target glucose 110-149 mg/dL

Question 16

treatment of postrenal AKI

Answer 16

removal of obstruction, supportive therapy (electrolyte management, fluid management)

Question 17

hypovolemic considerations

Answer 17

normal saline is IV fluid of choice

Question 18

hypervolemic considerations

Answer 18

reduce IV fluids to “keep vein open”
conc of IV meds
conc of tube feeds

Question 19

diuretics should be reserved for ___

Answer 19

hypervolemic patients who make adequate urine in response to diuretics

Question 20

diuretics examples

Answer 20

• furosemide (Lasix)
• torsemide (Demadex)
• bumetanide (Bumex)
• ethacrynic acid (Edecrin)= reserved for pts with sulfa allergy

Question 21

potency of IV loop diuretics

Answer 21

bumetanide:torsemide:furosemide (1:20:40)

Question 22

potency of IV loop diuretics

Answer 22

bumetanide

Question 23

which loop has the best oral bioavailability?

Answer 23

bumetanide

Question 24

which loop has longest duration of action?

Answer 24

torsemide

Question 25

goal of diuretics

Answer 25

maintain urine output >1 mL/kg/hr until euvolemic

Question 26

continuous administration of diuretics

Answer 26

fewer adverse rxns (myalgia, ototox); more natriuresis occurs; more expensive and requires more monitoring

Question 27

continuous administration of diuretics

Answer 27

fewer adverse rxns (myalgia, ototox); more natriuresis occurs; more expensive and requires more monitoring

Question 28

causes of diuretic resistance

Answer 28

excessive Na intake, inadequate dose, reduced bioavailability, nephrotic syndrome, reduced renal blood flow (drugs, hypotension), increase Na resorption

Question 29

how can you restore function from diuretic resistance?

Answer 29

add thiazide or potassium-sparing diuretics

If CrCl less than 30 mL/min, thiazides lose effectiveness (except for metolazone)

Question 30

what is not recommended as treatment fro AKI?

Answer 30

dopamine

Question 31

what is the most common non-pharm treatment that AKI pts receive?

Answer 31

renal replacement therapy (RRT)

Question 32

indications for RRT

Answer 32

Acid-base abnormalities
Electrolyte imbalance
Intoxication
fluid Overload
Uremia