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PathoPharm > lewis ch 46 (AKI, CKD, kidney transplant, dialysis) > Flashcards

lewis ch 46 (AKI, CKD, kidney transplant, dialysis) Flashcards

1
Q

descriptors of acute kidney injury (5 - onset, caused by, classified by, (non)reversible, cause of death)

A
  • sudden
  • caused by acute tubular necrosis
  • classified by acute reduction in urine output and/or elevated serum creatinine
  • potentially reversible
  • cause of death: infection
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2
Q

descriptors of chronic kidney disease (5- onset, caused by, classified by, (non)reversible, cause of death)

A
  • gradual onset over years
  • caused by diabetic neuropathy
  • classified by GFR<60 for >3 months and/or kidney damage >3 months
  • progressive and irreversible
  • cause of death: cardiovascular disease
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3
Q

S+S acute kidney injury (4)

A
  • rapid loss of kidney function
  • rise in serum creatinine and/or reduced urine output
  • elevated BUN and potassium
  • azotemia (accumulation of waste products)
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4
Q

5 causes acute kidney injury

A
  • recent infection
  • certain meds
  • severe dehydration
  • exposure to heavy metals or toxic solvents
  • blood loss, shock
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5
Q

type of acute kidney injury:

sudden and severe drop in bp or interruption of blood flow to kidneys from severe injury or illness

A

prerenal

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6
Q

type of acute kidney injury:

direct damage to kidneys by inflammation, toxins, drugs, infection, or reduced blood supply

A

intrarenal

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7
Q

type of acute kidney injury:

sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury

A

postrenal

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8
Q

three phases of acute kidney injury

A

oliguric
diuretic
recovery

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9
Q

rifle classification for acute kidney injury

A 
R: risk
I: injury
F: failure
L: loss
E: end-stage renal disease
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10
Q

classifications for oliguric phase of acute kidney injury (3)(related to urinary system)

A
  • urine output <400 mL/day
  • urinalysis: RBC, WBC, casts, protein
  • specific urine gravity: 1.010
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11
Q

during oliguric phase of AKI, decreased urine output causes fluid retention which is evidenced by (4)

A

hypertension
JVD
edema
bounding pulse

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12
Q

manifestations of oliguric phase of acute kidney injury (other body systems) (6)

A
  • metabolic acidosis
  • hyponatremia
  • hyperkalemia
  • leukocytosis
  • increased BUN and creatinine levels
  • fatigue, seizures, coma
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13
Q

classifications of diuretic phase of acute kidney injury (4) (relating to urinary system)

A
  • daily urine output between 1-5 L
  • increased GFR
  • decreased BUN and creatinine
  • dehydration and hypovolemia
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14
Q

classifications of recovery phase of acute kidney injury (3)

A
  • GFR increases
  • BUN and creatinine levels plateau then drop
  • lasts up to 12 months
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15
Q

diagnostic studies for acute kidney injuries (5)

A
  • labs: creatinine, BUN, electrolytes
  • urinalysis
  • ultrasound
  • CT
  • renal biopsy
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16
Q

meds for AKI

A
  • loop diuretic

- osmotic diuretic

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17
Q

example of loop diuretic med

A

furosemide

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18
Q

example of osmotic diuretic med

A

mannitol

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19
Q

dietary changes for treatment of AKIs

A
  • restrict sodium, potassium, and phosphate
  • adequate protein
  • adequate carbs and increased fat
  • calcium supplements
20
Q

in what populations is chronic kidney disease more commonly seen (4)

A
  • older adults
  • obesity
  • diabetes
  • hypertension
21
Q

2 defining factors of CKD

A
  • kidney damage

- low GFR (<60 mL/min for more than 3 months)

22
Q

stages of CKD

A

1, 2, 3a, 3b, 4, 5

23
Q

S+S end stage renal disease (7)

A
  • edema
  • high bp
  • ammonia breath odor
  • anemia
  • increased potassium
  • dry, itchy, yellow tinted skin
  • bone pain and muscle cramps
24
Q

most serious electrolyte disorder in kidney disease

A

hyperkalemia

25
Q

one of most important goals with CKD

A

blood pressure control (usually hypertensive)

26
Q

most effective treatment of hyperkalemia

A

dialysis

27
Q

med that can be given to treat hyperkalemia with CKD

A

kayexalate

28
Q

3 meds that can be given to treat anemia with CKD

A

epoetin alfa
darbepoeitin alfa
iron

29
Q

contraindications for kidney transplant (6)

A
  • advanced cancer
  • untreated heart disease
  • chronic respiratory failure
  • extensive vascular disease
  • chronic infection
  • unresolved psychosocial disorders
30
Q

3 types kidney transplant rejection

A

hyperacute
acute
chronic

31
Q

type of kidney transplant rejection:

  • minutes to hours after
  • antibody-mediated
  • remove transplanted organ
A

hyperacute

32
Q

type of kidney transplant rejection:

  • days to months after
  • can be reversible
A

acute

33
Q

type of kidney transplant rejection:

  • months to years
  • irreversible
A

chronic

34
Q

• Movement of fluid/molecules across a semipermeable membrane from one
compartment to another
• Used to correct fluid and electrolyte imbalances and removes waste products in
kidney failure

A

dialysis

35
Q

two methods of dialysis

A 
peritoneal dialysis (PD)
hemodialysis (HD)
36
Q

when should a patient be started on dialysis

A

GFR <15

37
Q

• Water and fluid removal
• Results when there is an osmotic gradient or pressure gradient across membrane
-moves extra fluid into dialysate

A

ultrafiltration

38
Q

what causes ultrafiltration in peritoneal dialysis

A

glucose in dialysate

39
Q

what causes ultrafiltration in hemodialysis

A

pressure gradient

40
Q

three stages of peritoneal dialysis

A

fill
dwell
drain

41
Q

osmotic agent in peritoneal dialysis

A

dextrose

42
Q

S+S of peritonitis during PD (5)

A
  • abdominal pain
  • fever
  • N/V
  • distention
  • increased bowel sounds
43
Q

two types of access in hemodialysis

A

AV fistulas and grafts

temporary vascular access

44
Q

how long is the AV access site created before it is needed for hemodialysis

A

3 months

45
Q

what should you hear/feel when assessing AV fistula/graft during hemodialysis

A

thrill

bruit

46
Q

how often should you monitor VS during hemodialysis

A

30-60 mins

47
Q

4 complications with hemodialysis

A
  • hypotension
  • muscle cramps
  • loss of blood
  • hepatitis

PathoPharm (42 decks)

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