T. Kidneys

Question 1

Kidney disease

Answer 1

Characterized by an abrupt decline in kidney function, so a rise in serum creatinine or a reduction in urine output

Question 2

RIFLE

Answer 2

risk, injury, failure, loss, end-stage kidney disease

Criteria. AKI, acute kidney injury; ESRD, end-stage renal disease; GFR -glomerular
filtration rate; UO, urine output.

Question 3

Acute kidney injury

Answer 3

• also known as acute renal failure (ARF)
• sudden episode of kidney failure or kidney damage that happens within a few hours or a few days.
• causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your body. (ie. hyperkalemia)
• Caused by pre renal or intrarenal and post renal.
– Acute tubular necrosis is the most common Intrarenal cause
• rise in serum creatinine and a decrease in urine output

Question 4

Acute tubular necrosis

Answer 4

• damage to the tubule cells of the kidneys
• primarily the result of ischemia, nephrotoxins or sepsis.
• the kidneys are swollen and pale.
• ATN is the most common intrarenal cause of AKI

Question 5

Chronic Kidney Disease

Answer 5

• Involves progressive, irreversible loss of kidney function
• or a decreased glomerular filtration rate (GFR)
• main causes are DM and hypertension

Question 6

Glomerular filtration rate (GFR)

Answer 6

in chronic kidney disease <60 mL/minute/1.73m2 for 3 months or longer

Normal GFR 125 mL/minute

End-stage renal disease (ESRD) occurs when GFR < 15 mL/minute

Question 7

Uremia

Answer 7

• a buildup of toxins in your blood.
• It occurs when the kidneys stop filtering toxins out through your urine.
• Uremia is often a sign of end-stage renal (kidney) disease.

Question 8

Polyuria

Answer 8

production of abnoramally large amounts of dilute urine

Question 9

anuria

Answer 9

failure of kidneys to produce urine

Question 10

oliguria

Answer 10

production of small amounts of urine

Question 11

Sodium polystyrene sulphonate

Answer 11

• drug for chronic kidney to treat hyperkalemia
• Cation-exchange resin
• Resin in bowel exchanges potassium for sodium

binds itself to potassium in your digestive tract. This helps prevent your body from absorbing too much potassium

Question 12

CKD-MBD

Chronic kidney disease—mineral and bone disorder

Answer 12

• A systemic disorder of mineral and bone metabolism due to CKD manifested by either one or a combination of the following: • Abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism.
• Phosphate intake restricted to <1 000 mg/day
• Phosphate binders
• Supplementing vitamin D
ª Controlling secondary hyperparathyroidism
• Cobtrol anemia
• Dyslipidemia

Question 13

Calcimimetic agents

Answer 13

Increase sensitivity of calcium receptors in parathyroid glands
used for CKD-MBD

Question 14

Dyslipidemia

Answer 14

elevated total or low-density lipoprotein (LDL) cholesterol levels, or low levels of high-density lipoprotein (HDL) cholesterol

Question 15

Dialysis

Answer 15

• The movement of fluid and molecules across a semipermeable membrane from one compartment to another.
• Blood moves from the blood through a semipermeable membrane (dialyzer) and into a dialysis solution (dialysate)
• Corrects fluid and electrolyte imbalances, removes wastes,

Question 16

Ultrafiltration

Answer 16

– water and fluid removal

Question 17

Peritoneal Dialysis

Answer 17

• placement of catherter into the abdominal wall
• peritoneal dialysis uses the lining on the inside of the belly as a natural filter for blood
• resulting in less accumulation of potassium, sodium and fluid

Question 18

hemodyalysis

Answer 18

• a dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean your blood
• accessed through 
-- Arteriovenous fistulas and grafts
-- Central venous catheters
-- Temporary vascular access

Question 19

Arteriovenous fistula

Answer 19

fistula created by anastomosing an artery and a vein.

Question 20

Kidney Transplantation

**may need to listen to this slide

Answer 20

Ethical issues
Recipient selection
Histocompatibility studies
Donor sources
-- Living donors
-- Deceased donors
Immuno-suppressive therapy

Question 21

Prerenal AKI

Answer 21

occurs due to factors external to the kidneys that reduce systemic circulation, thus reducing renal blood flow. This decrease in blood flow leads to decreased glomerular perfusion and filtration of the kidneys; this is the direct result of decreased perfusion.
• is reversible with treatment if there is no damage to the kidney tissue

Question 22

Intrarenal AKI

Answer 22

is caused by injury to the kidney itself.

Question 23

Postrenal AKI

Answer 23

is related to obstruction in the outflow of urine.

Question 24

Nephrotoxins

Answer 24

• an cause obstruction of intrarenal structures by crystallizing or by causing damage to the epithelial cells of the tubules
• Intrarenal Cause of AKI

a toxic agent or substance that inhibits, damages or destroys the cells and/or tissues of the kidneys

Question 25

The oliguric phase of AKI

Answer 25

• 1 to 7 days of injury to the kidneys
• reduction in urine output to less than 400 mL/day
• lasts on average about 10 to 14 days
• Hyperkalemia, Hyponatremia, high BUN, high cr4eatine

Question 26

The Diuretic Phase of AKI

Answer 26

• daily urine output of 1 to 3 L/day
• kidneys have recovered the ability to excrete wastes but not to concentrate urine
• large losses of fluid and electrolytes, monitor the patient for hyponatremia, hypokalemia, and dehydration

Question 27

The Recovery Phase of AKI

Answer 27

• begins when the glomerular filtration rate (GFR) increases
• BUN and creatine plateau then decrease
• kidney function may take up to 12 months to stabilize