Acute Kidney Injury Flashcards Preview

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Flashcards in Acute Kidney Injury Deck (31)
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1
Q

Prostaglandin vasodilation

A

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

2
Q

Glomerulus

A

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

3
Q

Re absorption and secretion

A

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

4
Q

Geriatric considerations

A

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

5
Q

Prerenal

A

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

6
Q

Intrarenal

A

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

7
Q

Post renal

A

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

8
Q

Acute tubular necrosis

A

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
Q

Contrast induced nephropathy

A

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
Q

Aki oliguric phase

A

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

11
Q

Aki diuretic phase

A
Starting to heal
Inability to concentrate urine
Output 3-5 L/ day
Fluid volume deficit
Electrolyte imbalances: hypo atria and hypokalemia (dumping )
12
Q

Aki recovery phase

A

May take up to 12 months to fully recover from aki

BUN/ creatinine normalize

13
Q

Creatinine clearance

A

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

14
Q

Blood urea nitrogen

A

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

15
Q

Serum creatinine

A

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

16
Q

Calculated glomerular filtration rate

A

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

17
Q

Pre renal diagnostic study

A

BUN/CR ratio elevated in pre renal

Fraction of excreted sodium normal in pre renal

18
Q

Intrarenal diagnostic study

A

Intrarenal normal bun/ cr ratio

FEna elevated

19
Q

Urinalysis

A

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

20
Q

Pre renal prevention and early intervention

A

The #1 cause is priceless

Prevent infection and heavy fluid resuscitation

21
Q

Intrarenal prevention and early intervention

A

Screen for risk factors in CAM

Treat strep infections

22
Q

Contrast associated nephropathy

A

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
Q

Nephrotoxic drugs

A
Aminoglycosides
NSAIDs
Cephalosporins 
Tobramycin
Vancomycin
Chemotherapy 
Norepinephrine
(Monitor trough levels)
75% of meds are metabolized through the kidneys
24
Q

Uremia

A

Hold on to nitrogenous waste products bun and creatinine

Itchy, drowsy, confused, irritable, decreased mentation, GI disturbances, uremic frost

25
Q

Managing hyperkalemia

A

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
Q

When to start dialysis

A

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
Q

Dialysis complications

A

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
Q

Before dialysis

A

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

29
Q

After dialysis

A

Fluid volume status, weight checks

30
Q

Peritoneal dialysis complications

A
Exit site infection
Peritonitis
Abdominal hernia
Lower back pain
Intraperitoneal bleed
Pulmonary complications
Protein loss
31
Q

Nephron

A

Does the work and makes the urine