urologic problems: acute kidney injury Flashcards
Acute Kidney Injury
ischemic injury r/t volume depletion and decreased perfusion, toxins, sepsis
AKI initiates…
inflammatory response
vascular response
cell death
3 classifications of AKI
prerenal
intrarenal
postrenal
common causes of prerenal AKI
inadequate perfusion r/t:
-hypotension
-hypovolemia
-sepsis
-inadequate CO
-renal vasoconstriction
-renal artery stenosis
characteristics of prerenal AKI
-decreased GFR d/t low glomerular filtration pressure
-failure to restore blood volume and BP
-O2 devices can cause ischemic cell injury and necrosis
characteristics of intrarenal AKI
occurs IN kidney
-prerenal can become intrarenal (low BP and hypovolemia cause ischemia and inflammatory response in kidney)
rhabdomyolysis
breakdown of damaged skeletal muscles –> causes bone pain
most common cause of intrarenal AKI is
acute tubular necrosis (ATN)
-nephrotoxic ATN: abx, metals, contrast, rhabdomyolysis
post renal AKI
RARE condition –> usually occurring with (urinary tract obstruction)
-bladder outlet obstruction
-prostatic hyperplasia
-bilateral ureteral obstruction
-tumor
-neurogenic bladder
*obstruction causes increase in pressure, can be felt by kidneys
labs associated with AKI
GFR <90
UOP <30
BUN >20
Cr >1.2
is AKI reversible or irreversible?
reversible IF we remove offending agent
Creatinine
0.5-1.2
how well kidneys are removing waste
chemical compound leftover from energy production in muscles
BUN
10-20
byproduct of PROTEIN breakdown normally filtered out of blood by kidney
clinical manifestations of AKI
oliguria (<400mL/day)
begins 1 day after hypotensive event & lasts 1-3 weeks
goal of pharm treatment in AKI
stabilize patient until kidney function is returned
