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Flashcards in acute kidney injury 3 Deck (27):
1

what is caused by direct damage to the kidney?

intrinsic renal failure

2

what are the 4 categories of intrinsic renal failure
(hint: based on primary site of damage)

1. tubules
2. vessels
3. interstitium
4. glomerulus

3

what is the most common catergory of intrinsic renal failure?

acute tubular necrosis (ATN)

4

what are two major causes of acute tubular necrosis?

ischemia and toxins

5

what is the etiology of ATF?

1. tubular cells die
2. slough into the tubular lumen forming casts
3. tubular pressure increases

6

what are the 3 most common IRF categories in order?

1. ATN
2. interstitial nephritis
3. acute glomerular nephritis

7

hypoperfusion overtime often leads to what?

ischemia

8

acute tubular necrosis leads to what 3 things?

1. loss of urine concentrating ability
2. defective distal sodium reabsorption
3. reduced GFR

9

what are the phases seen in the clinical course for acute tubular necrosis

oliguric phase
diuretic phase
recovery phase

10

what are the two endogenous causes of ATN?

1. myoglobin
2. hemoglobin

11

what are the exogenous causes of ATN?

1. cisplatin
2. aminoglycosides
3. radiocontrast media
4. cyclosporine
5. heavy metals
6. amphotericin B
7. foscarnet

12

rhabdomyolysis from trauma or statins can cause what problem in kidney

ATN due to myoglobin in blood

13

what is the most common cause for allergic interstitial nephritis

antibiotics

14

allergic interstitial nephritis can be caused by what things other than drugs

1. autoimmune diseases (lupus)
2. infiltrative diseases (sarcoidosis)
3. infections

15

what is the MOA of allergic interstitial nephritis

allergic hypersensitivity response.
usually cell mediated, predominantly by T-lymphocyte infiltrate

16

acute GN is typically treated by what

immunosuppressants or plasmapheresis

17

what is the typical cause of postrenal failure

obstruction of urine flow

18

what are 4 causes of obstruction of urine flow

1. bladder outlet obstruction
2. urethral obstruction
3. crystal deposition
4. drugs

19

what drugs commonly obstruct urine flow

1. acyclovir
2. sulfonamides (Bactrim)
3. methotrexate
4. indinavir
5. vancomycin

20

what are the most common causes of postrenal failure (nonpharm causes)?

1. benign prostatic hyperplasia (BPH)
2. malignancy

21

what counseling must be given with Bactrim related to kidney disease?

drink lots of water

22

what are 3 treatment plans for postrenal failure?

1. d/c drugs (if possible; antibiotics may be necessary)
2. relieve obstruction (with foley catheter)
3. immunologic therapy for GN (corticosteroids)

23

at what level of SCr above baseline should ACEI's and ARB's be stopped

more than 30% above baseline

24

what patients should not receive an ACEI or ARB with AKI?

dehydrated prerenal patients

25

what is treatment for prerenal disease?

1. aggressive fluid replacement if dehydrated
2. manage electrolytes (usually K Mg and phosphate)

26

what patients require caution when giving fluid replacement for prerenal disease

those with CHF or cirrhosis
pt.s who are anuric or oliguric
pt's without hypovoemia

27

what should be done with anuric or oliguric patients when treating

fluid restriction