Renal Failure Flashcards
Acute Kidney Injury (AKI) results in a sudden _____
is characterized as an increase in ___________
decrease in kidney function
serum creatinine
What is less than 400-500ml of urine/day
Oliguria
What results in an inability to maintain acid- base, fluid, and electrolyte balance and to excrete nitrogenous wastes.
AKI
AKI can be divided into what three categories
(a) Prerenal
—- Kidney hypoperfusion (low blood flow or pressure) leading to decreased GFR
(b) Intrinsic kidney disease
(c) Postrenal
—- Obstructive uropathy
Signs and symptoms of what issue?
(1) Buildup of waste products can sometimes cause nonspecific symptoms and signs collectively termed uremia
(a) Nausea, vomiting, altered sensorium, pericarditis, malaise
(2) Pericardial effusion leading to tamponade and friction rub
(3) Arrhythmias
(4) Rales in hypervolemia
(5) Nonspecific diffuse abdominal pain and ileus
(6) May experience symptoms and signs of the underlying disease process causing their AKI.
(7) May be hyper or hypovolemic depending on underling disease process.
AKI
What is the MOST common etiology of AKI
1) 40-80% of cases
2) If reversed quickly with renal blood flow damage to kidney tissue 3) If hypoperfusion persists it can lead to a secondary intrinsic kidney injury
4) Decreased renal perfusion occurs in several ways
Prerenal
Prerenal happens in what % of cases
40- 80%
What type of AKI
a) Up to 50% of cases
b) Considered after prerenal and postrenal causes are ruled out
c) Sites of injury include:
—(1 Tubules
—(2 Interstitium
—(3 Vasculature
—(4 Glomeruli
Instrinsic Kidney Disease
what type of AKI
a) Least common cause (5-10%)
b) Important to detect because they are reversible
c) Causes include:
— Urethral obstruction (Stones, strictures)
— Bladder dysfunction or obstruction
— Obstruction of both ureters/renal pelvises
— BPH (most common cause in males)
— Cancer (bladder, prostate, and cervical)
Postrenal
Treatment for Prerenal
(a) Depends entirely on the cause
—Achieving euvolemia
—Restoring renal perfusion
(b) Avoiding nephrotoxic drugs
Treatment for Postrenal
(a) Bladder catheterization
(b) Relieve underlying cause
Treatment for intrinsic
(a) Usually self-limited
(b) Managed by nephrology
Complications for AKI
(1) Need for dialysis
(2) Arrhythmias secondary to electrolyte abnormalities
(3) Bleeding/clotting disorders
(4) Encephalopathy
(5) Cardiac tamponade
True/False
For AKI Most patients will be a MEDEVAC
True
Follow up
(a) Prerenal =
(b) Postrenal=
(c) Intrinsic=
(a) Prerenal = May be referred to Emergency medicine, cardiology, or internal medicine
(b) Postrenal = Urology referral to relieve obstruction
(c) Intrinsic = Nephrologist
