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Cardio-Renal I FINAL > Therapeutics - Cassagnol AKI > Flashcards

Therapeutics - Cassagnol AKI Flashcards

1
Q

explain what an AKI is – what time period it occurs over

A

ABRUPT decrease in renal function. occurs over HOURS TO DAYS

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2
Q

explain the negative things that are happening to a person with an AKI

A

nitrogenous wastes accumulating

can’t balance fluid and electrolytes

acid-base imbalance

oliguria/anuria

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3
Q

what is the term for the accumulation of nitrogenous wastes?
(occurs in AKI)

A

azotemia

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4
Q

differentiate between oliguria and anuria

A

oliguria – less than 400mL/ day of urine output

anuria - less than 50mL a day of urine output

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5
Q

briefly, what is a CKD

A

PROGRESSIVE deterioration of kidney function. IRREVERSIBLE structural damage to the nephrons – can be early stage or late stage

lot of times due to HTN or diabetes

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6
Q

define end stage renal disease (ESRD)

A

less than 15mL/min/1.73m OR need dialysis

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7
Q

“chronic renal replacement therapy”

A

same as dialysis

if a pt needs - they have ESRD

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8
Q

**macroalbuminuria and microalbuminuria

A

macroalbuminuria (proteinuria) – MORE THAN 300mg/24 hours of albumin in the urine

microalbuminuria - 30-300mg/24 hours of albumin in the urine

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9
Q

Define dialysis

A

process that removes excess water and toxins from the body – these have accumulated bc of the patient’s renal function and they need to be removed by this “external kidney”

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10
Q

true or false

it is normal to have a little bit of protein in the urine

A

FALSE - should be none

indicates damage to the basement membrane of the glomerulus

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11
Q

true or false

only patients with CKD may need dialysis

A

FALSE

AKI may need it temporarily until their kidneys recover

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12
Q

what is the MDRD equation and what is it used for

A

it’s an estimate of glomerular filtration rate (GFR) – determines baseline kidney function

1 of the things we can use to determine the STAGING of CKD

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13
Q

true or false

the MDRD equation is NOT USED to determine kidney function in cases of AKI

A

TRUE

only used to stage in patients who have CKD. – patients who are validated as stable

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14
Q

creatinine clearance is an estimate of….

A

GFR

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15
Q

what equation is used to dose medications for patients with CKD

A

cockcroft gault equation

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16
Q

cockcroft gault equation:

A

140-age (IBW) / 72 *Scr

multiply by 0.85 if female

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17
Q

major limitation of creatinine clearance via cockcroft gault

A

MUSCLE MASS!! varies greatly, esp with age

therefore, for over 65, if SCr comes back less than 1, just round up to 1. if over 1 tho, just use that number

dont want to overestimate old ppl’s CrCl just bc their SCr is low due to decreased muscle mass

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18
Q

2 ways to categorize AKIs

A

RIFLE

AKIN

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19
Q

name all of the RIFLE classes

A

risk
injury
failure
loss of function
end stage kidney disease

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20
Q

differentiate between the AKI RIFLE classes of “loss of function” and “end stage kidney disease”

A

loss of function - complete loss of function for over 4 weeks

ESRD - complete loss of function for over 3 months – getting to the chronic point

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21
Q

when looking at AKI categorizing, the ____ change is more valuable than the ____ change

A

RELATIVE CHANGE more relative than absolute

-like a 3x decrease in GFR is significant — not just the number it is

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22
Q

challenge with using urinary output to stage AKIs with RIFLE

A

pts may spill – really only way to get accurate value is with an indwelling category

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23
Q

differentiate between the SCr bump between the RIF parts of RIFLE AKI staging

A

R - SCr bump 1.5x over baseline

I - SCr bump 2x over baseline

F - SCr bump 3x over baseline

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24
Q

*anuria definition

A

less than 50 mL a day

25
Q

**which 2 lab values are used the MOST in order to diagnose an AKI

A

BUN and SCr

BUN:SCr ratio should be LESS THAN 20:1

if over – indicates decreased renal blood flow – PRERENAL ISSUE!!!!

26
Q

what does FENa mean and what is it used for

A

fractional excretion of sodium

can be used in the diagnosis of an AKI

27
Q

explain what these mean:

FENa <1%
FENa >2%

FENa between 1-2%

A

if less than 1% – the reabsorptive capacity of the kidney is INTACT

if over 2% – the reabsorptive capacity of the kidney is IMPAIRED due to the damage

between 1-2% is inconclusive. usually due to a diuretic

28
Q

the BUN:SCr ratio is normal, but the kidneys are still failing

what could this indicate

A

intra or post renal cause - not prerenal

29
Q

briefly differentiate between prerenal, function/intrinsic, and postrenal causes of AKI

A

prerenal - BEFORE KIDNEY issue. there is no structural damage to the kidney, but it is still failing. BUN:SCr ratio would be over 20

function/intrinsic - damage to the kidney itself – ATN (acute tubular necrosis), AIN, etc

postrenal - obstruction AFTER the kidney is causing it to fail. ureter obstruction – stone, etc

30
Q

an AKI due to radio contrast media is considered to have what etiology

A

function/intrinsic – called contrast-induced nephropathy

31
Q

most common functional cause of an AKI

A

ATN (acute tubular necrosis)

32
Q

*some drugs affect the afferent and efferent arterioles and can thus cause an AKI

explain this

A

NSAIDS constrict the afferent arteriole and ACE’s and ARBS dilate the efferent arteriole. this, along with a diuretic causing volume depletion, can lead to a SEVERE AKI due to lack of proper perfusion

this is a PRERENAL cause

33
Q

patient develops an AKI due to depleted intravascular volume - also leading to hypotension and shock

what is the etiology

A

prerenal

34
Q

name 3 drugs that can cause an AKI through direct damage to the kidney (function/intrinsic etiology)

A

quinolones
penicillins
sulfas

35
Q

true or false

bladder obstruction is a postrenal cause of AKI

A

true

36
Q

crystallizing drugs that cause AKI have what etiology?

name some

A

postrenal

sulfonamides
triamterene
methotrexate
acyclovir
indinavir

37
Q

**2 MAJOR risk factors for getting an AKI

A

dehydration
nephrotoxin exposure

38
Q

CIN (contrast induced nephropathy) presents within….

A

48 hours

important to watch the patient and that they stay hydrated

39
Q

3 phases of AKI

A

oliguric phase (less than 400 mL/day)

diuretic phase (sign that the kidneys are healing)

recovery phase (days-months)

40
Q

***__________ is PARAMOUNT in terms of treating AKIs

A

finding and reversing the cause!!

41
Q

true or false

drugs that have caused an AKI should be discontinued

A

true

may be able to reinitiate depending on how much the patient needs the drug – but if you do, lower the dose and monitor the patient more frequently

42
Q

pt had AKI .___ are preferred over ____ for analgesia

A

acetaminophen preferred over NSAIDS (they constrict the afferent arteriole!)

43
Q

treating AKI:

-remove offending agent (may possibly restart when AKI resolves)

what is the other important thing to do?

A

CORRECT THE PERFUSION ISSUE

may need to add or take away fluid, and optimize meds

44
Q

AKI due to streptococcal glomerulonephritis is considered which category of etiology?
what is the treatment?

A

intrinsic/function
supportive care-

loop diuretics, sodium/water/protein restriction to manage edema/proteinuria (if present)

antibiotics, antihypertensives

45
Q

glomerulonephritis due to autoimmune/vasculitis

what is the etiology?

treatment?

A

intrinsic/function

supportive treatment is immunosuppressants (bc immune mediated) – corticosteroids, cyclophosphamide, azathioprine, etc

46
Q

treatment for an AKI caused by acute tubular necrosis

A

supportive care – diuretics to help with the fluid and electrolyte imbalance

NO DOPAMINE – INEFFECTIVE (for both prevention AND treatment)

47
Q

how can ATN caused by contrast dye be prevented?

A

FLUIDS! - normal saline, sodium bicarb fluid, ascorbic acid, NAC

48
Q

dose of NAC for CIN prevention

A

600mg PO BID for 2 doses (before and after the contrast) AND concomitantly administer sodium bicarb

49
Q

2 drugs that need to be considered when trying to prevent contrast-induced nephropathy

A

if the pt is on metformin - need to hold before the contrast and for AT LEAST 48 hours afterwards bc risk of lactic acidosis

also, avoid diuretics to flush the dye bc this can lead to volume depletion - a prerenal cause on its own!

50
Q

how to prevent ATN caused by aminoglycosides

A

use extended interval dosing over traditional dosing like BID or TID

51
Q

aminoglycosides cause ATN or AIN

A

ATN

52
Q

2 things that can cause ATN

A

contrast dye
aminoglycosides

53
Q

AKI due to AIN treatment
what category of etiology is this

A

d/c offending agent, and can consider corticosteroids

intrinsic etiology

54
Q

AKI due to post renal etiology treatment

A

correct the obstruction – if nephrolithiasis, encourage 2 LITERS OF FLUID A DAY!!!

can add a thiazide diuretic and restricted sodium diet, allopurinol

can also alkanalize the urine with potassium citrate or potassium-mg-citrate

55
Q

true or false

pt got drug-induced AKI due to drug-induced post renal obstruction

we need to ensure that we are giving the patient the correct renal dosing for that drug

A

true

56
Q

*indications for extracorporeal renal replacement therapy (dialysis)

A

AEIOU

acid-base disorders
electrolyte disturbances (hyperkalemia)

drug Intoxication

fluid Overload

symptomatic uremia (high levels waste in blood)

57
Q

AKI and drugs

A

the risk-benefit for that drug needs to be assessed, and temporarily discontinuing (or permanently)

also, every med the patient is taking that is eliminated by the kidneys needs to be reassessed and possibly reduced dose – bc they can accumulate

58
Q
A

Cardio-Renal I FINAL (13 decks)

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