week 11 patho Flashcards
what are some v basic characteristics of AKI
abrupt decline in kidney function, with elevated serum creatinine and reduction in urine output
how high will creatinine be with an AKI
1.5 times their baseline
what are the three main patient groups at risk for developing an AKI
patients with infections
patients with low BP (because kidneys aren’t being perfused)
patients exposed to nephrotoxins
how does sepsis cause an AKI
widespread vasodilation will lower BP, which decreases perfusion to the kidneys, also antibiotics used to treat sepsis are bad for the kidneys
what are the three types of AKI
1) pre renal
2) intra renal (intrinsic)
3) post renal
what are three causes of pre renal AKI
hypovolemia: decreased perfusion to kidneys
altered peripheral vascular resistance: ex. sepsis, anaphylaxis
cardiac disorders which ultimately lower CO and BP
bacically all have to do with decrease in glomerular filtration and BP
what are 5 causes of intra renal AKI
prolonged ischemia
nephrotoxic drugs
organic solvents like ethylene glycol
acute hemolysis or rhabdomyolysis
acute glomerulonephritis (inflammation of glomerulus)
how does acute hemolysis and rhabdomyolysis cause intra renal AKI
breakdown of these produces a substance called He which is nephrotoxic
what are the main nephrotoxic drugs
ahminoglycosides! anything that ends with -mycin
tobramycin
streptomycin
what are some examples of post renal factors of AKI
Kidney stones
enlarged prostate
urethra scarring
basically anything that affects urine leaving the kidneys and going down the urinary tract (gets all clogged up)
what is azotemia
less waste excreted in the kidneys
what happens inside the nephron during a pre renal AKI
- decreased blood flow disrupts balance of pressure in glomerulus
- glomerular hydrostatic pressure is lost as it drops
- decrease in overall GFR
- kidney activates raas to compensate, not enough to maintain GFR so you get oliguria and azotemia
what do casts in urine indicate
it means cells are dying which indicates intratubular damage
what is happening in the nephron during an intrarenal AKI
- lack of blood flow injures tubules
- causes inflammation, swelling, and loss of fx
- when epithelial cells die, they sluff off and get clogged in renal tubules
- this obstructs movement of filtrate and increases intratubular pressure
what is happening in the nephron during a post renal AKI
physical obstruction of outflow of urine leads to increased pressure in glomerulus and overall decreased GFR
what is an early intervention for a pre renal injury AKI
normalising BP
what is an early intervention for a post renal AKI
removing obstruction
what happens if you don’t intervene for a pre renal or post renal AKI
you get an intra renal injury
what are the three phases of an intra renal AKI
initiation, maintenance, recovery
what happens during initiation phase of infrarenal AKI
what sx do you see
increased Cr and BUN, decreased urine output
what happens during maintenance phase of an intrarenal AKI
- urine output
- body fluid
- acid/base balance
- electrolytes
-you see a drop of urine output by 10-14 days
-you see fluid retention which includes hypertension, edema, and weight gain
-you see metabolic acidosis
and electrolyte imbalance (low Na, high K, low Ca, high PO4)
- you see anemia
what do you see in the recovery phase of an intra renal AKI
Diuretic phase, hyponatremia and hypokalaemia,
how long does the kidney typically take to stabilise after an intrarenal AKI
12 months
what are the top 3 priorities a nurse would have when caring for a patient in the maintenance phase of ATN
1) fluid balance, make sure they aren’t hypovolemic
2) monitor acidosis
3) monitor EKG d/t high potassium
why would a patient in the recovery phase of ATN be hypovolemic
due to fluid loss in the diuretic phase
what is glomerulonephritis
immune mediated swelling of the urinary tract
how does glomerulonephritis affect the urine
it causes proteinuria, hematuria, decreased UO and oliguria
does acute glomerulonephritis affect both kidneys or just one
both
what are the 2 types of glomerulonephritis
1) acute glomerulonephritis
2) rapidly progressive glomerulonephritis
3) chronic glomerulonephritis (initial illness resolves but inflammation persists)
4) nephrotic syndrome (loss of large amounts of protein in the urine)
what is acute poststreptococcal glomerulonephritis?
an immune attack on strep infection that causes antibody complexes to form and cause damage to the glomerulus
when would you see kidney injury after a strep infection
5-21 days after initial infection
what symptoms would you see in APG
periorbital edema, smoky urine, HTN, increased Ur and Cr
why are infecitons most common in the urinary tract
because the urinary tract is a very sterile place
what is the most common pathogen leading to UTI
E. coli
what is stasis and why is it a major cause of UTI
basically the biggest defence against bacteria is peeing because it flushes all the bacteria out. if you don’t pee pathogens have more of a change to travel up the urinary tract. this is why dehydration is a risk factor
what are the 2 main risk factors for UTI
Females
urinaty stasis
why are women more at risk for UTI
because they have a shorter urethra so bacteria won’t travel up as far
whats the main difference between cyctitis and pyelonephritis
cystitis is a lower UTI issue that stays in the urinary tract and bladder
Pyelonephritis when the infection climbs upwards towards the ureters and kidneys
which one can lead to CKD, cystitis or pyelonephritis
pyelonephritis
whats the biggest difference in urinalysis between cyctitis and pyelonephritis
pyelonephritis will have leukocyte casts, indicating damage in tubules whereas cystitis won’t because the infection isn’t in the kidneys yet
what is renal calculi aetiology
theyre mineral salts in urine that precipitate out and form stones
whats the difference between calculus and lethiasis
calculus is a stone, lethiasis is just stone formation
what is the most common type of kidney stone
calcium (phosphate or oxalate)
which type of kidney stone comes from recurrent UTI
struvite
which type of stone is associated with gout
uric acid
which type of kidney stone is the least common
cystine
what is the main factor associated with kidney stone formation
dehydration
what are the 5 symptoms of renal calculi
- abdominal/flank pain
- renal colic
hematuria
fever
N/V
what does renal colic feel like
its excruciating pain that comes and goes as body tries to push stones down, radiates toward groin area
what is polycystic kidney disease
it is basically when the Cortex and medulla become filed with cysts that enlarge and destroy surrounding tissue
