UNIT 3- ACUTE KIDNEY INJURY

Question 1

Using the acronym A WET BED what are the functions of the kidney?

Answer 1

A: Acid-Base Balance

W: Water removal
E: Erythropoiesis
T: Toxin Removal

B: Blood pressure control
E: Electrolyte balance
D: Vitamin D activation

Question 2

What is renal failure?

Answer 2

Inability of the kidneys to excrete waste products and water from blood stream through filtration

1. AKI and CKD

Question 3

What is the patho of AKI?

Answer 3

1. Acute, rapid loss of renal function
   -oliguria may be present
   -Uremia may be present

Question 4

AKI is characterized by?

Answer 4

1. Rapid decrease in renal function
2. Increase in serum, BUN, K+
3. Decrease of urine output
4. Azotemia- biochemical abnormality, defined as elevation or buildup of nitrogenous products

Question 5

What are the 3 major categories of AKI?

Answer 5

1. Prerenal- coming before the kidneys
2. Intrarenal- within the kidney
3. Postrenal- After the kidneys

Question 6

What causes prerenal AKI?

Answer 6

Due to decreased blood flow into the kidneys

1. absolute loss of fluid
   -hemorrhage
   -Vomiting
   -Diarrhea
   -Severe burns
2. Relative loss of fluid (fluid stays the same
   -Distributive shock
   
   • Congestive heart failure– cant pump blood which leads to less blood delivered to kidneys
3. renal artery issues- renal artery stenosis

Question 7

What causes post renal AKI?

Answer 7

1. Obstruction from the outflow of the kidney

Question 8

What are two ways obstruction can cause post-renal AKI?

Answer 8

1. Compression- intra-abdominal tumors or tumors
2. Blockage-Kidney stones

Question 9

What is intrarenal AKI?

Answer 9

1. Damage to the tubules, the glomerulus, or the in interstitum (the space between the tubules)

Question 10

What is the most common cause of intrarenal AKI?

Answer 10

1. Acute tubular necrosis

Question 11

What is acute interstitial nephritis?

Answer 11

Inflammation that can happen w/in days to weeks and damage the kidneys interstitum

Question 12

What are the 4 phases of AKI?

Answer 12

1. Initiating phase
2. Oliguric phase
3. Diuretic phase
4. Recovery phase

Question 13

What is important to know about the initiating phase of AKI?

Answer 13

Renal blood flow decreases to a level resulting in severe cellular depletion that in turns leads to acute cell injury and dysfunction

Renal tubular epithelial cell injury is a key feature.

Question 14

What is important to know about the oliguric phase?

Answer 14

1. Decreased urine output (<400/day) occurs within 10-14 days lasts typically

Question 15

What does the GFR look in the oliguric phase?

Answer 15

Increased GFR and
increased BUN & Cr

Question 16

What is important to know about the diuretic phase in AKI?

Answer 16

“kidneys waking up phase”

1. output increases to about 1-3L/day can be up to 5L
2. Nephrons not fully functional even w/output
3. 1-3 wks, monitor electrolytes

Question 17

What would you expect the GFR during the diuretic phase to looking like in AKI

Answer 17

1. Decreased BUN, CR
2. Increased GFR

Question 18

What does the recovery phase look like with AKI?

Answer 18

1. Lasts 1-2 weeks but may take up to 12 months
2. Some do not recovery.

Question 19

True or False: AKI will have an increased blood pressure on initial visit?

Answer 19

True

Question 20

AKI s/s

Answer 20

1.decreased urine out put
2. Swelling of the legs, ankles, feet (edema)
3. SOB (dyspnea)
4. Fatigue
5. Loss of appetite
6. N/V
7. Irregular heartbeat
8. Chest pain/pressure
9. Easy or unusual bleeding (decreased platelets)
10. Confusion