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Therapeutics > AKI > Flashcards

AKI Flashcards

1
Q

Definition of AKI
An abrupt , within ____ reduction in kidney function currently defined as :

  1. Absolute incr in ____ within 48 hrs or
    2.INCR in ___ which is known or presumed to have occurred within the prior ___ OR
  2. A reduction in ___
A

48 hrs

  1. Scr of >0.3 mg/dL
  2. Scr>50% (>1.5x baseline), 7 days
  3. urine output (Documented oliguria of <0.5 mL/kg/hr for >6 hrs)
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2
Q

ETIOLOGY : Hemodynamic
-Intravasc ___
DECR ____
___ /Shock
___ or constriction
___ vasoconstrictors
___ vasodilators

A

volume depletion
circulating volume
hypotension (Hemmorhage or sepsis)
renal vascular occlusion
afferent arteriole (CI)
efferent arteriole (ACE ARB Renin I)

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3
Q

ETIOLOGY : Intrinsic and Obstructive

___disorders
___necrosis
Acute ____

N
B
P
C

A

Glomerular
acute tubular
interstitial nephritis

Nephrolithiasis
BPH
Pregnancy
Cancer

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4
Q

Hemodynamic AKI

Presentation
-SCr?
BUN/Scr ratio?
Marked and acute decr in __
onset?
Urinalysis is likely ???
FeNa< ___
Urine Na?

A

Abrupt incr Scr
>20
urine output
hours to days
normal unless sustained hypotension leading to tubular damage
<1%
<20 meq/L

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5
Q

Calculation of fractional Excretion of Sodium FeNa ?

A

= (Urine Na * Plasma Cr ) / (urine Cr *Plasma Na) ALL MULTIPLIED BY 100

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6
Q

Drug induced hemodynamic AKI

Which drugs ? (4)

A

ACEI/ARB/Renin inhibs (Dilate EA)
CI , cyclo and tacro (Constrict AA)
Diuretics (Hypovolemia)
NSAIDS/COX2 Inhibs (aff vasoconstrict)

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7
Q

Acute Tubular Necrosis : Presentation

Onset ?
Rise in scr over ____
FeNa ?
Urine Na?
What can be present on UA?
Sx’s? (3)

Etiology ? (3)

A

days to weeks
days
>1
>40 meq/L
Casts
N/V/Oliguria

Prolonged hypotension or decr renal perfusion such as sepsis or blood loss
-if u leave acute hemodynamic aki untx’ it can cause this

-rhabdomyolysis
-nephrotoxins

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8
Q

Nephrotoxins that can cause acute tubu necrosis
A,A,C,C,I,P,R,V

A

Aminoglycosides (Elevated trough concs over 3 days, multiple daily dosing, duration over three days)
Amphotericin B
Cisplatin
Cyclophosphamide
Ifosfamide
pentamidine
radiocontrast media
vancomycin

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9
Q

Acute Interstitial Nephritis
Presentation ?

+/- (4)
FeNa?
Urine Na?
Onset?
Diagnosis often confirmed by ?

Etiiology ? (3)

nephrotoxins that can cause this?

A

Body rash, UA positive for protein and WBCS, blood or urinary eosinophils, gallium scan of kidney.
>1 %
>40
Days to weeks
Renal Biopsy

idiopathic, viral meds

NSAIDS, quinolones, semisynthetic penicillins (ampi, nafcil, oxa)
Sulfonamides, rifampin

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10
Q

Tubular Disorders
Presentation
+/- LOW SERUM ? (3) HIGH SERUM?
urinalysis?
High urinary ?
gradual rise in Scr
Onset months to yrs

Nephrotoxins?

A

Potass, phos, bicarb, chloride
+/- Urinalysis with glucose , protein
+/- high urinary phos

Tenofovir (Fanconi)
Ifosfamide (Fanconi)
Lithium (Nephrogenic DI)

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11
Q

Obstructive Nephropathy
Presentation —>
Rise in ?
___pain
F, C
N/V
A___
U___
H___
H__
+/- UA with __,__ and __

Etiology ? (C,N,M,P,E,P,P)

A

Rise in scr acute and chronic forms
flank
fever/chills
anuria
urinary hesitancy
Hematuria
hydronephrosis
Crystals, RBCS and WBCs

Congen vesicoureteral reflux
nephrolithiasis
medications
pregnancy
enlarged prostate
prostate cancer
pelvic cancer

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12
Q

Drug induced Crystalluria?
Adam and Ida never met queen sally turner

A

acyclovir, allopurinol, indinavir, nelfinavir, mtx, quinolones, sulfonamides, triamterene

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13
Q

High Risk and AKI STages 1-3 Prevention and tx

Discontinue all ___
Ensure __ and ___
COnsider functional ___
Monitor __ and __
Avoid ___
COnsider alts to __

A

Nephrotoxins
adequate volume and perfusion P
hemodynamic monitoring
scr, urine output
hyperglycemia
radiocontrast procedures

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14
Q

Volume Status : Hydration
What’s preferred and why?
Dosing?

A

Sodium chloride or sodium bicarb , they improve renal blood flow

Sodium Chloride 0.9% 1L over 2 hrs

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15
Q

Loop Diuretics :
Diuretics are reserved for ?
Often used by physicians to?
USed in pt’s who are __ and respond to ?

A

Volume overload
convert oliguric AKI to non oliguric aki
volume overloaded, initial dose of loop diuretic

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16
Q

Indications for ACUTE DIALYSIS : AEIOU

Describe each term

A

Acidosis : Metabolic acidosis with pH <7.1

Electrolytes : HYPERkalemia with K>6.5 meq/L or rapidly rising potass

Intoxication : OD with salicylates, lithium, methanol, ethylene glycol, theophylline, pentobarb

Overload : Volume overload resistant to diuretics evidenced by pulm congestion, ededma, Weight gain

Uremia : Signs ->Percarditis , neuropathy, unexplained decline mental status, no absolute Scr/BUN indication for dialysis

17
Q

HEMODIALYSIS FOR AKI

IHD what criteria? (3)
CRRT (4)

A

Pt’s with hemodynamic stability, overdose cases, hyperkalemia

Hemodynamic INSTABILITY,
ICU pt’s catabolic and with better control of uremia,
excessive volume overload, Sepsis, SIRS

18
Q

Types of CRRT
1. CVVH
-___ venovenous hemofiltration
-___ clearance
-NO ____
-Replacement solution administered either __ or ___
Large molecules

  1. CVVHD
    -Continuous ____
    -___ clearance
    -___ only
    Small to medium molecules
  2. CVVHDF
    -What is it?
    ___ and ___ clearance
    __ and replacement solutions (20L)
    Blood flow maintained by ___
A

continous
convective
dialysis solution
pre , post filter (25-50L)

venovenous hemodialysis
diffusive
dialysate

Continuous venovenous hemodiafiltration
convective, diffusive
dialysate
pump

19
Q

Determinants of Drug Removal By Dialysis

Drug dependent factors? (4)
Therapy dependent factors? (5)

A

protein binding, volume of distrib, molecular weight, drug charge

Type of modality, effluent flow rate, blood flow rate, fluid replacement (pre/post)
Hemofilter

20
Q

Drugs with a high degree of _____ are ___ to be removed by dialysis
Only ___ or ____ is removed by dialysis
Examples?

A

protein binding >90%, LESS LIKELY
unbound, free drug

Ceftriaxone or warfarin

21
Q

Drugs with Small ___ are located in intravascular space and more ____
Drugs with large Vd (>___) likely distributed at other tissue sites

A

Vd , <0.3 L/kg
likely to be removed by dialysis

> 1L/kg

22
Q

Molecular weight
Most drugs have a MW of ?
-It’s not a major determinant of removal since?
-Which drugs are heavier ?

A

<1500 daltons (1 Da = 1 g/mol)

new hemofilters have large pore size

daptomycin, vancomycin

23
Q
A

Therapeutics (15 decks)

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