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NRSG 326 > Week 2: AKI > Flashcards

Week 2: AKI Flashcards

1
Q

What is AKI?

A

Previously known as acute renal failure (ARF) encompasses a subset of people who have an abrupt decline in kidney function

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2
Q

How does normal pathology of the kidneys work?

A
  1. Blood enters the kidney where inside is the nephron
  2. The nephron takes in the unfiltered blood, removes the vitamins and nutrients and passes them through its tubule while pushing the filtered blood back out
  3. The nutrients are absorbed out of the tubules based on the body’s needs, and the remainder is excreted in urine
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3
Q

How does the pathophysiology of AKI work?

A
  1. Blood enters the kidneys, into the nephrons
  2. Some of the nephrons are obstructed or have died which then causes a reduce in blood volume circulation
  3. The patient may not be able to fully filter the blood in their body and may need to be placed on dialysis so we can let the kidney rest
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4
Q

What is Pre renal causes?

A

Factors external to the kidneys, a decrease in PREfusion
Hypovolemia
decreased PVR and CO
vascular obstruction

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5
Q

Pre renal causes mean what to the body?

A

A decrease in systemic circulation which means a decrease in renal blood flow and resulting in a decrease in GFR/filtration

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6
Q

What are some medications that cause pre renal?

A

vasoactive medications :
ACEIs
ARBs
epinephrine
large doses of dopamine

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7
Q

What are intra renal causes?

A

conditions that cause direct damage to the renal tissues (most the time is an ATN)
- prolonged ischemia and nephrotoxins usually
- hemoglobin released from hemolyzed RBCs
- myoglobin from necrotic muscle cells
- ATN most common

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8
Q

What is ATN?

A

Acute tubular necrosis
- most common cause of intra renal AKI
- primairly results from ischemia, nephrotoxins or sepsis

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9
Q

What is the pathophysiology of ATN?

A

Damage to the epithelial cells of the nephrons which can be reversible, but if not result in nephron death

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10
Q

What are post renal causes?

A

mechanical obstruction of urinary outflow
- urine flow is obstructed and backs into the renal pelvis and impairs kidney function
BPH
prostate cancer
calculi (kidney stones)
trauma
external tumours (extra renal)

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11
Q

Azotemia

A

Accumulation of nitrogen waste products (BUN and creatinine) in the blood

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12
Q

How does the kidney disease improving global outcomes define AKI (creatinine level, urine volume)

A

Increase of serum creatinine value of >26.52mmol/L in 48 hrs
creatinine of >1.5 times baseline within the prior 7 days
urine volume <0.5 mL/kg/hour for 6 hours

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13
Q

What are exposures that may cause AKI?

A

Some Call Carrie But Tonight Carrie Made No Real Progress

sepsis
critical illness
circulatory shock
burns
trauma
cardiac surgery
major non cardiac surgery
nephrotoxic drugs
radio contrast agents
poisonous plants/animals

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14
Q

What are some susceptibilities that may cause AKI?

A

Dawn And Fred Both Cant Clean Dawns Creaky Apartment

Dehydration
advanced age
female gender
black race
CKD
Chronic diseases
DM
Cancer
Anemia

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15
Q

What is normal hourly UO?

A

0.5-1.5 ml/kg/hr (50ml/hr)

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16
Q

What is GFR?

A

Info on how the kidneys are working, used to estimate kidney function

17
Q

What is eGFR

A

not the patients actual GFR (thats expensive) but instead uses creatinine as the marker to identify kidney function

18
Q

What is used to calculate eGFR?

A

creatinine, sex, age and sometimes race

19
Q

What is creatinine?

A

A breakdown product of creatine phosphate from muscle and protein metabolism

20
Q

What causes creatinine increases

A

excessive protein intake, creatinine supplements, intense workouts, dehydration, AKI

21
Q

What causes creatinine decreases

A

rare, but pregnant women (augmented clearance rates), poor nutritional status

22
Q

What is BUN

A

digestion of protein which produces ammonia, ammonia is changed to urea nitrogen in the liver

23
Q

What can increase BUN?

A

muscle wasting, high protein diet, GI bleed, glucocorticoids, age

24
Q

What is rhabdomyolysis?

A

Breakdown of muscle from prolonged period of lying

25
Q

What is the initation phase of AKI?

A

Characterized by an increase in creatinine and BUN and a decrease in urine output

26
Q

What occurs with fluid volume excess in the maintenance phase of AKI

A

urinary output decreases which results in fluid retention

S&S:
- distended neck veins
- bounding pulse
- edema
- pulmonary and pleural effusions

27
Q

What occurs with metabolic acidosis in the maintenance phase of AKI?

A

kidneys cant synthesize ammonia which serum bicarbonate then decreases trying to buffer the circulating hydrogen ions that are not being excreted

S&S:
- kussamaul rests
- lethargy
- LOC changes

28
Q

What urinary changes occur during the maintenance phase of AKI

A

oliguria is most common (<400ml/24hr)
- urine with normal specific gravity and high sodium concentration

29
Q

What hematological changes occur during the maintenance phase of AKI

A

anemia from impaired erythropoietin production
altered WBC = immunocompromised
uremia = bleed

30
Q

What sodium imbalances occurs with the maintenance phase of AKI

A

damaged tubules cannot conserve Na which means it is excreted nice and hyponatremia occurs

excess intake is not recommended due to volume expansion, HF, HTN

31
Q

What potassium imbalances occur in the maintenance phase of AKI

A

hyperkalemia from impaired excreting ability

S&S
- often asymptomatic
- can have weakness
- can lead to lethal cardiac arrhythmias

32
Q

What neurological conditions occur in the maintenance phase of AKI

A

waste product accumulation in the brain and nervous tissue

S&S:
- fatigue
- concentration
- seizures
- stupor
- coma

33
Q

Calcium and phosphate changes in the maintenance phase of AKI

A

vitamin D needed for calcium absorption, but only functional kidneys produce vitamin D
hypocalcemia occurs and body release PTH to release Ca from bone, which also release phosphate and created excess phosphate levels

34
Q

What is the recovery phase of AKI?

A

return of BUN, creatinine and GFR
- urine output increases, but kidneys may not be able to handle a 1-3L jump, resulting in hypovolemia and hypotension

35
Q

What is the purpose of a urinalysis?

A

analyses the urine sediment for abundant cells, casts, or proteins that suggest an intra renal disorder

36
Q

What is the purpose of a renal ultrasound?

A

often done first to establish information about the renal anatomy and function (blood flow, integrity) - this also does not require nephrotoxic contrast to do so

37
Q

What is the purpose of a CT angiography?

A

identifies lesions and masses/obstructions - this one does in fact give exposure to radiation and nephrotoxic contrast

38
Q

Why is an MRI not recommended for AKI diagnosis?

A

gadolinium is the contrast used and this is associated with nephrogenic systemic fibrosis

39
Q

What is the purpose of blood tests?

A

To determine the eGFR, creatinine and BUN

NRSG 326 (3 decks)

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