Acute Kidney Injury Flashcards Preview

Complex Care > Acute Kidney Injury > Flashcards

Flashcards in Acute Kidney Injury Deck (31):
1

Prostaglandin vasodilation

Prostaglandin causes renal vasodilation it is also a pain mediatiator be careful with NSAIDs because they prevent prostaglandin

2

Glomerulus

Non selective filtration dumps everything except the big molecules red blood cells and protein

3

Re absorption and secretion

Potassium chloride and sodium are re absorbed into tubular capillaries from the proximal tubules loop of he le and distal tubule

4

Geriatric considerations

Structural kidney changes loss if renal mass and nephrons=greater risk of kidney injury but are not automatically functional loss

5

Prerenal

External factors that reduce kidney blood flow ex-hypovolemia fluid shifts sepsis heart failure liver failure anaphylaxis blood clots stiffening of renal artery

6

Intrarenal

Direct damage to kidney tissue causing impaired function of the nephron ex glomerulonephritis interstitial nephritis acute tubular nephritis contrast induced nephropathy

7

Post renal

Mechanical obstruction of urine outflow ex bph bilateral ureter obstruction foley blockage

8

Acute tubular necrosis

Most common intrarenal aki
Damage to basment membrane of tubular epithelium, necrotic tissue sloughs off , tubules become blocked
Causes- prolonged pre or post renal failure, hemolyzed red blood cells, increase in myoglobin

9

Contrast induced nephropathy

Risk factors- dehydration, hypotension, sepsis, use of nephrotic ix meds, greater than 100 ml of contrast, GED less than 60, or older than 75

10

Aki oliguric phase

Inability to produce urine
Output less than 0.5 ml/kg/hr
Fluid volume overload
Electrolyte imbalances hyperkalemia

11

Aki diuretic phase

Starting to heal
Inability to concentrate urine
Output 3-5 L/ day
Fluid volume deficit
Electrolyte imbalances: hypo atria and hypokalemia (dumping )

12

Aki recovery phase

May take up to 12 months to fully recover from aki
BUN/ creatinine normalize

13

Creatinine clearance

Required 24hr urine collection
Approximates Gfr
70-135mL/min/m2

14

Blood urea nitrogen

6-20mg/dL
Measures urea excretion
Can be influenced by non renal factors infection fever trauma steroid therapy diet

15

Serum creatinine

0.6-1.3 mg/dL
End product of muscle/ protein metabolism
More reliable than BUN
Requires vein puncture

16

Calculated glomerular filtration rate

115mL/min
Based on mdrd equation
Adjusted for gender, African Americans, and age

17

Pre renal diagnostic study

BUN/CR ratio elevated in pre renal
Fraction of excreted sodium normal in pre renal

18

Intrarenal diagnostic study

Intrarenal normal bun/ cr ratio
FEna elevated

19

Urinalysis

Casts= intrarenal failure indicate damage to various parts of tubules
Protein, hematuria, Pyuria, alterations in urine specific gravity

20

Pre renal prevention and early intervention

The #1 cause is priceless
Prevent infection and heavy fluid resuscitation

21

Intrarenal prevention and early intervention

Screen for risk factors in CAM
Treat strep infections

22

Contrast associated nephropathy

Avoid in patients at high risk
Hydrate 12 hrs before and after
Give 3 doses of mycomyst po
Evaluate function for 72 hrs after

23

Nephrotoxic drugs

Aminoglycosides
NSAIDs
Cephalosporins
Tobramycin
Vancomycin
Chemotherapy
Norepinephrine
(Monitor trough levels)
75% of meds are metabolized through the kidneys

24

Uremia

Hold on to nitrogenous waste products bun and creatinine
Itchy, drowsy, confused, irritable, decreased mentation, GI disturbances, uremic frost

25

Managing hyperkalemia

Diuretics (lasix)
Polystyrene sulfonate (kayexalate)
Insulin and dextrose
Calcium gluconate- cardiac protective agent doesn't decrease potassium just makes sure they don't code

26

When to start dialysis

Volume overload compromising respiratory and cardiac status
Elevated potassium not responding to treatment
Severe metabolic acidosis
Bun 120mg/dL
Significant change in mental status
End of life considerations

27

Dialysis complications

Infection
Hypotension
Blood loss
Bleeding
Hepatitis
Disequilibrium syndrome- happens 1st or 2nd time large amount of solute shifts causes bad headaches and sometimes seizures
Arterial steal syndrome- right after fistula or graft put in do not have good perfusion distal to site

28

Before dialysis

Weight checks, fluid volume status, communicate well with dialysis nurse and pharmacist ask whether you should give meds anti hypertensives usually held

29

After dialysis

Fluid volume status, weight checks

30

Peritoneal dialysis complications

Exit site infection
Peritonitis
Abdominal hernia
Lower back pain
Intraperitoneal bleed
Pulmonary complications
Protein loss

31

Nephron

Does the work and makes the urine