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HOSPITAL > RENAL > Flashcards

RENAL Flashcards

1
Q

What is azotemia?

A

Elevated nitrogen containing compounds (urea, creatinine)

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2
Q

At what 3 locations can azotemia occur?

A

Pre, renal, or post-renal

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3
Q

If a patient has severe azotemia that is symptomatic and can cause metabolic acidosis and electrolyte disturbances – what is this known as?

A

Uremia

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4
Q

How do we stage AKI?

A

RIFLE (risk, injury, failure) class

AKIN (acute kidney injury network) stage

KDIFO (kidney disease improving global outcomes) guideline

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5
Q

What is something that a nurse would call and notify you about that has changed for the patient, that would trigger you to think about AKI?

A

Decreases in urine output to less than 3ml/kg over 6 hours (or 0.5ml/kg/hr)
**Falls under KDIGO

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6
Q

We should always be checking creatinine levels when someone first enters the hospital, and re-checking. What change would indicate to us AKI?

A

Rises greater than 0.3mg/dl

**Falls under KDIGO

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7
Q

What are some of the clinical manifestation of AKI?

A

Often none

Edema, HTN, decreased UO, and changes in labs

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8
Q

What lab changes would you note with AKI?

A

Albuminuria, increased BUN, hyperkalemia, and hyponatremia

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9
Q

What would be some examples of prerenal azotemia?

A

Dehydration!!!! → Hypovolemia (may include blood loss)

Prolonged renal ischemia (acute tubular necrosis)

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10
Q

What are the two components of ATN? What causes each?

A

Ischemia (prolonged pre-renal)

Nephrotoxicity (NSAIDs, Abx, contrast dye)

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11
Q

What are some causes of Renal (intrinsic) Azotemia?

A

Glomerulonephritis (immune modulated) vs. Nephrosis (ischemia, contrast, toxins, DIC, precipitation)

Nephritis → Immune modulated

Minimal change disease (nephrotic syndrome)

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12
Q

What are some causes of postrenal azotemia?

A

Urinary obstruction = Prostatism, tumors, calculi, occasional urethra obstruction

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13
Q

What are some classic diagnostic testing we do for AKI?

A

UA, BUN, Cr, K, Na, Phosphate, Ca, CBC, and Renal/Pelvic US

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14
Q

How do we prevent AKI?

A

Sustain renal perfusion (fluid balance, blood volume, BP)

Don’t clog the pipes → prepare for planned exposure to contrast dye and check labs before!

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15
Q

What is the #1 most important step for treating AKI?

A

You must figure out the cause!!!

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16
Q

How do we treat AKI?

A

Meticulous limitation of intake = water, meds, proteins, K, Na, phosphate
If everything fails then consider a renal consult → Dialysis

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17
Q

What must we have prepped and ready for a renal consult?

A

BMP, Mg, Phosphate, UA, hemoglobin, and Renal US

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18
Q

What are some underlying medical co-mordidities that can lead to chronic kidney disease?

A

AKI, HTN, DM, and vascular disease

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19
Q

If the GFR is 60-89, what stage CKD?

A

2 (mild)

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20
Q

If the GFR is 30-44, what stage CKD?

A

3B

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21
Q

If the GFR is less than 15, what stage CKD?

A

5 (end stage)

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22
Q

If we have a patient in the hospital with CKD, what’s out #1 goal?

A

To prevent the development of acute-on-chronic kidney disease

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23
Q

If we have someone in the hospital with CKD, how do we manage them?

A

Diet (low sodium, potassium, protein, and phosphate)

Avoid nephrotoxins (NSAIDs and contrast)

Water management (think about your IVF!!!)

24
Q

What is the primary intracellular cation?

A

Potassium

25
Q

AKI, CKD, diet high in potatoes or bananas, hemolysis, metabolic acidosis, beta blockers, insulin deficiency, or aldosterone antagonists – can all cause what?

A

Hyperkalemia

26
Q

What do we see on EKG with hyperkalemia?

A

Peaked T waves! With widening PR, QRS

27
Q

What do we see on PE with hyperkalemia?

A

Weakness and Paralysis

28
Q

How can we treat hyperkalemia?

A

Treat the cause

IVF

Kayexelate

Limit potassium

Insulin + dextrose

Beta adrenergics (albuterol neb)

29
Q

If a patient has metabolic alkalosis due to excessive V/D (laxatives) or renal diuretics/hypomagnesemia – what can they all lead to?

A

Hypokalemia

30
Q

What do you see on PE with Hypokalemia?

A

Weakness, rhabdomyolysis

Glucose intolerance

31
Q

What would you see on EKG with hypokalemia?

A

U waves

32
Q

How do you treat hypokalemia?

A

Potassium replacement! (PO vs. IV for symptomatic, should be KCl)

ALWAYS CHECK Mg AND REPLACE IF NEED BE!!!

Consider hyperglycemia and DKA

33
Q

What is the primary extracellular cation?

A

Sodium

***AKA we’re moving onto the natremias…

34
Q

If we discover that someone is hypernatremic – what must we figure out next?

A

If their urine is dilute or highly concentrated

35
Q

What would cause a patient to be hypernatremic with highly concentrated urine?

A

Extrarenal water loss (on a desert island)

Fever, sweating, diarrhea, mechanical ventilation

36
Q

What would cause a patient to be hypernatremic with dilute urine?

A

Osmotic diuresis (something is in there, and it’s got to come out)

DKA, Diabetes insipidus (central = low ADH, Nephrogenic = unresponsive to ADH)

37
Q

If we have determined that a person is hypernatremic with dilute urine – what do we need to figure out next?

A

Polyuric? (is their urine output greater than 3L/day)

If yes, is the urine osmolality: +300mOsm/L (indicating osmotic diuresis)

Or Less than 150mOsm/L (indicating diabetes insipidus)

38
Q

If a patient is just dehydrated and that’s why they are hypernatremic – what do we do?

A

NS initially → transition to ½ NS

39
Q

How fast can we correct hypernatremia due to dehydration?

A

SLOW!

No faster than 0.5mEq/L/hour (to avoid cerebral edema)

40
Q

What does hyponatremia often indicate?

A

Increased water with relation to sodium

Often associated with elevated ADH

41
Q

Almost all patients that are hyponatremic are they also: hypoosmolar or hyperosmolar?

A

Hypoosmolar

*Just don’t worry about hyperosmolar

42
Q

So, when we figure out someone with Hyponatremic Hypoosmolar – what must we figure out next?

A

Volume status!

Hypervolemic, Hypovolemic, or Euvolemic

Assess with Hx, exam, Urine Na, and urine osmolality

43
Q

What would be some causes for HypERvolemic Hyponatremic?

A

CHF!!! Cirrhosis or nephrotic syndrome → they have EDEMA

44
Q

What would we see on labs with hypervolemic hyponatremic?

A

Na = 125 (140 is NORMAL)

Baroreceptors are increasing ADH secretion since circulation is inadequate (ADH is high) → thus the kidneys are retaining both water and salt

45
Q

If a patient is hypOvolemic hyponatremic – where should we look for the source?

A

Renal or Non-renal causes

Renal = Urine Na 30+mmol/L

Non-renal = Urine Na less than 30mmol/L

46
Q

If the urine Na is over 30 in a hypOvolemic hyponatremic patient – what are some possible causes?

A

Diuretics!!! (thiazides)

Primary adrenal insufficiency

Cerebral salt wasting

47
Q

If the urine Na is less than 30 in a hypOvolemic hyponatremic patient – what are some possible causes?

A

GI!!!!

Vomiting, diarrhea, dehydration

48
Q

If a patient is euvolemic but their labs come back with a sodium of 116 – what are they?

A

Euvolemic Hyponatremic

49
Q

In a Euvolemic hyponatremic patient, what must we look at next?

A

Can they concentrate their urine

UrOsm 100+ (urine remains relatively concentrated, despite excess water in blood)

UrOsm less than 100 (unable to concentrate urine)

50
Q

What are some causes of Euvolemic hyponatremia with concentrated urine?

A

SIADH!!!!

Secondary adrenal insufficiency, renal insufficiency, hypothyroidism

51
Q

What are some causes of Euvolemic hyponatremia with inability to concentrate urine?

A

Psychogenic polydipsia (they’re literally drinking from the toilet)

Tea & Toast diet

52
Q

So, like we said earlier almost all of Hyponatremias are associated with elevated ADH levels – what would cause elevated ADH in a hospitalized patient?

A

Pain, volume depletion, trauma, meds (SSRI, diuretics), neoplasms, neurophyschiatric meds

53
Q

How do we treat acute symptomatic hyponatremia?

A

Saline (normal 0.9%)

Loop diuretic

Recheck Serum Na and Urine Osmol every 1-2 hours

54
Q

How do we treat chronic symptomatic hyponatremia?

A

Brief stint of 3% saline (ALWAYS from nephrology input)

Stop NaCl when suren Na rises, Urine Osm falls, or symptoms resolve

55
Q

What must we remember about the IVF we give for hyponatremia?

A

The UrOsm should be LESS than whatever you’re giving

56
Q

How do you treat chronic ASYMPTOMATIC hyponatremia?

A

Fluid restriction (best/safest initial)

Increase solute intake

D/C offending agents

ADH receptor antagonist

57
Q

How do you treat hypovolemic hyponatremia?

A

NaCl

HOSPITAL (12 decks)

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