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SD- Hospital > Renal Lecture > Flashcards

Renal Lecture Flashcards

1
Q

Acute kidney injuy (AKI) complicates _____% of hospital admissions

A

15-20%

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2
Q

Increased nitrogen containing compounds (urea, creatinine)

A

Azotemia

(can have preenal, renal, postrenal)

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3
Q

RIFLE
AKIN
KDIGO

A

ways to stage AKI

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4
Q

Rise in creatinine > 0.3
Decreased urine output to < 3 mL over 6 hours

A

AKI

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5
Q

Severe azotemia
Symptomatic
Metabolic acidosis
Electrolyte disturbances

A

Uremia

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6
Q

Often no visual signs or noticeable sxs
Edema
HTN
Decreased urine output
Labs: albuminuria, increased BUN, hyperK, hypoNa

A

AKI

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7
Q

Causes:
Inadequate perfusion
Hypovolemia
Inadequate PO intake
GI losses
Diuretics
Blood loss
Cardiac or hepatic failure
Sepsis

A

AKI pre-renal azotemia

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8
Q

MC cause of acute renal failure

*excess nitrogen compounds due to lack of blood flow to each kidney

A

Pre renal azotemia

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9
Q

Prolonged renal ischemia from prerenal azotemia can cause..

A

Acute tubular necrosis (ATN)

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10
Q

Which type of renal tubular acidosis..?

Decreased H+ excretion
Hypokalemic

Herditary vs acquired (hyperPTH)

A

Type I (distal)

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11
Q

Which type of renal tubular acidosis..?

Decreased proximal bicarb reabsorption
Hypokalemic

Hereditary vs acquired (multiple myeloma, chem exposures)

A

Type II (proximal)

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12
Q

Which type of renal tubular acidosis..?

Impaired hydrogen and potassium excretion
Aldosterone deficiency or tubular unresponsiveness to aldosterone
Hyperkalemia

ie..Addison’s dz, DM

A

Type IV

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13
Q

Glomerulonephritis vs nephorsis

Caused by nephrotoxic things:
Ischemia
Radiocontrast
Toxins
DIC
Intrinsic arterial or venous obstruction
Intrarenal precipitation
Nephritis
Minimal change Disease

A

Renal azotemia (intrinsic)

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14
Q

Urinary obstruction
Prostratism
Bladder, pelvic, retroperitoneal tumors
Calculi
Urethral obstruction

A

Postrenal Azotemia

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15
Q

Causes:

AKI
HTN
DM
Vascular disease

A

CKD

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16
Q

30-300 mg/day albumin

A

microalbuminuria

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17
Q

17-250 mg/g for men

25-355 mg/g for women

A

Spot Ur albumin:creatinine ratio

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18
Q

What stage CKD:

GFR>90

A

Stage 1

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19
Q

What stage CKD:

GFR 60-89

A

Stage 2 (mild)

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20
Q

What stage CKD:

GFR 45-59

A

3A (moderate)

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21
Q

What stage CKD:

GFR 30-44

A

3B (moderate)

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22
Q

What stage CKD:

GFR 15-29

A

stage 4 (severe)

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23
Q

What stage CKD:

GFR <15

A

stage 5 (end stage)

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24
Q

Low sodium, protein, potassium, phosphate

A

CKD diet

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25
Q 
Diet (low Na, protein, potassium, phosphate)
Avoid nephrotoxins (NSAIDs, radiocontrast)
H20 management (THINK about IVF)
A

CKD management in-patient

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26
Q

What is the goal for hospital management of CKD?

A

prevent acute on chronic kidney disease/injury

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27
Q

What is the primary intracellular cation?

A

Potassium!

28
Q

What is the only way to measure potassium?

A

Extracellular (ECFV)

*there are very small quantities extracellularly

29
Q

Causes:

AKI or CKD
Adrenal insufficiency
Dietary intake (bananas, potatoes)
Hemolysis (blood draw, clotting, leukocytosis)
Metabolic acidosis
Beta blockers
Insulin deficiency
Aldosterone antagonists

A

Hyperkalemia

30
Q

Weakness
Paralysis
Cardiac arrhythmias: peaked T waves, widened PR, QRS, eventual PEA

A

HyperKalemia

31
Q

Tx:

tx the cause
IVF
Kayexelate
Limit intake
Insulin + dextrose
Beta adrenergics

A

Hyperkalemia

32
Q

Causes:

Decreased intake
Increased GI loss: vomit, diarrhea, laxatives, tube drainage
Increased renal loss: diuretics, hypoMg, non reabsorbable anions
Increased entry into cells: insulin, beta agonists or stress hypothermia, alkalosis

A

HYPOkalemia

33
Q

Manifestatios:

Weakness/rhabdomyolysis
Glucose intolerance
Cardiac arrhythmias- increased U wave amplitude

A

HYPOkalemia

34
Q

Tx:

PO or IV replacement
Mg replacement
Consideration in hyperglycemia and DKA

A

HYPOkalemia

35
Q

What is the main extracellular ion?

A

Sodium

36
Q

Causes:

  • *Extra renal water loss** (fever, sweating, diarrhea, mechanical ventilation)
  • *Renal water loss** (osmotic diruresis, iatrogenic)
A

HYPERnatremia

37
Q

DKA, hyperalimentation, mannitol, sodium
diabetes insipidus

all examples of _____ water loss, which can lead to hypernatremia

A

Renal

38
Q

For diabetes insipidus…

which is LOW ADH and which is UNRESPONSIVE TO ADH

(options= central, nephrogenic)

A

Central= low ADH

Nephrogenic= unresponsive to ADH

39
Q

1 amp NaHCO3 has ____x’s the concentration of 3% saline

A

2x’s

(NaHCO3 can be an iatrogenic cause of renal water loss)

40
Q

urine output is >3L/day

A

Polyuric

41
Q

>300 mOsm/L =?

A

Osmotic diuresis

42
Q

<150 mOsm/L= ?

A

Diabetes insipidus

43
Q

Give NS inititally if volume depleted
Transition to 1/2 NS vs. D5W

(avoid correction faster than 0.5 mEq/L/hr to avoid cerebral edema)

A

Tx for hypernatremia

44
Q

When giving hyperNa pt NS, avoid correction faster than 0.5 mEq/L/hr to avoid..?

A

Cerebral edema

45
Q

ADH elevation

Increased serum osmolality

Decreased circulating volume

Inappropriate elevation

A

Hypoosmolar HypoNatremia

46
Q

Increased levels of another osmolyte

  • glucose
  • mannitol
  • proteins
  • lipids
A

Hyperosmolar HypoNatremia

47
Q

“too much salt”

Seen with:
CHF
Cirrhosis
Nephrotic syndrome

***increased ADH due to decreased effective circulating volume
kidneys retain both Na and H20

A

Hypervolemic HypoNatremia

48
Q

Urine Na < 30 mmol/L indicates _______ (renal/extrarenal) losses

A

Extra renal

49
Q

Urine Na > 30 mmol/L indicates ______ (renal/extrarenal) losses

A

Renal

50
Q

Hypovolemic Hyponatremia (too little salt)

can be divided into…

A

Renal (>30 mmol/L Na in urine)

Extra-renal (<30 mmol/L Na in urine)

51
Q

Urine Na >30

RAA NOT engaged
Na is being released

A

Euvolemic HypoNa

52
Q

Psychogenic polydipsia
Beer potomania
Tea and toast diet

cause euvolemic hyponatremia with urine osmol ……

A

less than 100

53
Q

SIADH
Reset osmostat
Renal insufficiency
Hypothyroidism
TZDs
SSRIs
Secondary adrenal insufficiency

cause euvolemic hyponatremia with urine osmol _______

A

greater than 100

54
Q

this is an excess of water but we treat it like its a deficiency of Na

A

Hyponatremia

55
Q

Tx:

Saline.. normal (0.9%) vs 3%
Loop diuretic
Serum Na and urine osmol monitored every 1-2 hours

A

Acute Hyponatremia

56
Q

For hyponatremia…

Aim for 1-2 mEq/hr the first few hours then no more than 10mEq/L in the first 24 hours.

No more than 18mEq/L in ___ hours

A

48

57
Q

Pain
Volume depletion (followed by LR or hypotonic fluids
Trauma
Meds (SSRIs, TZDs)
Neoplasm
Severe nausea
Neuropsychiatric meds

A

common causes of increased ADH in hospitalized patients

58
Q

May briefly use 3% saline
Stop NaCl when serum Na starts to rise, urine osm decreases or symptoms resolve

A

Chronic symptomatic HypoNatremia Tx

59
Q

True or False..

There is a risk of osmotic demyelination syndrome if correction of chronic hyponatremia happens too rapidly

A

True

60
Q

154 mOsm/L
77 mEq/L

..which saline?

A

1/2 NS

61
Q

308 mOsm/L
308 mEq/L

which saline?

A

NS

62
Q

1026 mOsm/L
513 mEq/L

which saline?

A

3% saline

63
Q

130 mEq/L

which saline?

A

LR

64
Q

Fluid restrict

Safest initial approach

Increase solute intake

Discontinue offending agents

ADH receptor antagonist

tx for?

A

Chronic asymptomatic hyponatremia

65
Q

Usually asymptomatic

NaCl
Maintain ≤ 10mEq/24 hours correction

A

Hypovolemic Hyponatremia

SD- Hospital (10 decks)

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