urologic problems: acute kidney injury

Question 1

Acute Kidney Injury

Answer 1

ischemic injury r/t volume depletion and decreased perfusion, toxins, sepsis

Question 2

AKI initiates…

Answer 2

inflammatory response
vascular response
cell death

Question 3

3 classifications of AKI

Answer 3

prerenal
intrarenal
postrenal

Question 4

common causes of prerenal AKI

Answer 4

inadequate perfusion r/t:
-hypotension
-hypovolemia
-sepsis
-inadequate CO
-renal vasoconstriction
-renal artery stenosis

Question 5

characteristics of prerenal AKI

Answer 5

-decreased GFR d/t low glomerular filtration pressure
-failure to restore blood volume and BP
-O2 devices can cause ischemic cell injury and necrosis

Question 6

characteristics of intrarenal AKI

Answer 6

occurs IN kidney
-prerenal can become intrarenal (low BP and hypovolemia cause ischemia and inflammatory response in kidney)

Question 7

rhabdomyolysis

Answer 7

breakdown of damaged skeletal muscles –> causes bone pain

Question 8

most common cause of intrarenal AKI is

Answer 8

acute tubular necrosis (ATN)
-nephrotoxic ATN: abx, metals, contrast, rhabdomyolysis

Question 9

post renal AKI

Answer 9

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

Question 10

labs associated with AKI

Answer 10

GFR <90
UOP <30
BUN >20
Cr >1.2

Question 11

is AKI reversible or irreversible?

Answer 11

reversible IF we remove offending agent

Question 12

Creatinine

Answer 12

0.5-1.2
how well kidneys are removing waste
chemical compound leftover from energy production in muscles

Question 13

BUN

Answer 13

10-20
byproduct of PROTEIN breakdown normally filtered out of blood by kidney

Question 14

clinical manifestations of AKI

Answer 14

oliguria (<400mL/day)

begins 1 day after hypotensive event & lasts 1-3 weeks

Question 15

goal of pharm treatment in AKI

Answer 15

stabilize patient until kidney function is returned

Question 16

management of a patient with AKI

Answer 16

correct fluid & electrolyte imbalance (esp. hyperkalemia)

correct acid-base imbalance (metabolic acidosis) –> sodium bicarbonate

manage BP
avoid nephrotoxic drugs

Question 17

what drugs correct fluid/electrolyte imbalance?

Answer 17

-lasix: remove K

-dextrose and insulin: move K back into cells

-binders: help get K out of body through GI tract
(sodium polystyrene sulfonate, patiromer, sodium zirconium cyclosilicate)