Renal 2 (Week 13) Flashcards
What causes prerenal AKI
reduced blood perfusion of kidney
what causes reduced blood perfusion to kidneys
arterial hypotension
dehydration
sepsis
arterial occlusion (plaques, air bubbles, fat globules)
administration of ACE inhibitors or ARB meds
what do NSAIDs do
inhibit production of all types of prostaglandins
intrinsic AKI
damage to structures within the kidney
most common cause of intrinsic AKI
acute tubular necrosis
what causes acute tubular necrosis
renal ischemia
shock syndrome
causes of intrinsic AKI
acute tubular necrosis exposure to toxins such as -myoglobin -contrast dyes -aminoglycosides -infections (TSS) - auroimmunity -other pharmaceuticals
postrenal AKI due to
obstruction of flow in urinary system
causes of postrenal AKI
prosttatic hypertrophy or cancer
infection
improperly placed urinary catheter
nephrolithiasis (kidney stone)
primary means to determine presence of AKI
serum creatinine
urine output
other tests used to detect AKI
urine sedimentation urine osmolality and electrolytes serum electrolytes urinary specific gravity microscopic eval of urine blood urea nitrogen
what would you look for in microscopic eval of urine
bacteria
pieces of dead cells
-indicates infection or breakdown of cells (usually renal tubular cells)
blood urea nitrogen more useful for
monitoring chronic kidney disease
what happens as BUN levels increase above normal?
GFR decreases below normal
albuminuria
albumin (protein) in urine
how is chronic kidney disease defined (CKD)
abnormalities in kidney structure or function present for 3 months or longer
structural abnormalities seen in chronic kidney disease
albumuria
hemaaturia
presence of red cell casts
electrolyte abnormalities
what indicates a functional abnormality in CKD
drop in GFR
Biggest risk factor for CKD
diabetes
other risk factors for CKD
hypertension
60 y/o or greater
prognosis of CKD determined by
- cause of kidney disease
- GFR at diagnosis
- degree of albuminuria
- presence of other pathologies
what cause of kidney disease would yield a poor prognosis
autoimmune process
(increased/decreased) GFR at diagnosis yields a poor prognosis in CKD
decreased
(increased/decreased) albuminuria yields a poor prognosis in CKD
increased
what comorbid pathologies would yield a poor prognosis in CKD
diabetes
high BP
pulmonary disease
autoimmune disorders
what does KDOQI stand for
Kidney Disease Outcome Quality Initiative
what does the KDOQI categorize
categorizes CKD into categories based on GFR
(higher/lower) KDOQI level indicates worse prognosis
higher
how is hypertension related to CKD
- can cause or be a result of CKD
- retaining water and sodium
- derangements of angiotensin system
what does proteinuria have a direct proportion to?
risk of cardiovascular disease
nicotine causes vaso(constriction/dilation)
vasoconstriction
what does smoking do in relation to CKD
reduces GFR
increases BP
increases urinary albumin excretion
what does cigarette pack years help predict
how fast CKD will progress
hos is pack years calculated
packs per day x # years smoker
what is the relationship between smoking and CKD
obesity increases risk of G5 CKD
what does CKD progress into after several years
end stage renal disease
what type of tx are patients typically undergoing at ESRD
dialysis (or being considered)
what causes CKD to progress into ESRD
- ongoing loss of nephron mass
- glomerular capillary hypertension
- proteinuria
what happens with glomerular capillary hypertension
hypertrophy of remaining glomeruli; pores get larger; more protein goes through pores leading to proteinuria
what does erythropoietin do
secreted by kidney; acts on marrow to produce RBC
how is CKD related to anemia
decreased production and secretion of erythropoietin occurs due to damage and loss within kidney
what stage of CKD is anemia typically present
C3a and beyond
how is CKD related to osteoporosis
decreased elimination of phosphorus which leads to hyperphosphatemia and a decrease in calcium levels.
decreased conversion of vitamin D into its active form so less calcium absorption in gut
what happens in CKD in relation to acid base balance
CKD interferes with acid-base balance; CKD patients are acidotic
medical treatment for CKD
control acid/base balance
control electrolyte imbalances
antihypertensive medications (ACE inhibitors, ARBs)
how are electrolyte imbalances controlled in CKD
dietary restriction
-limit potassium, sodium, or water intake
Therapeutic treatment of CKD
diet- protein restriction, sodium restriction (elevated sodium increases BP and proteinuria)
exercise- achieve and maintain healthy BMI
smoking cessation- slows progression of CKD
pharmaceuticals- diuretics; treat sx/problems
