Flashcards in Acute Kidney Injury- Dr. Alex Deck (257)
What is acute kidney injury?
-Rapid deterioration in renal function resulting in the accumulation of nitrogenous waste (BUN-Azotemia)
-Inability of the kidney to regulate electrolyte, acid-base, and/or water homeostasis
What is the timeline for acute kidney injury?
Days to weeks in development (under 3 months)
What factors are not included in the definition of acute kidney injury?
-No specific level of BUN or K
-Clinical signs or symptoms
What is diagnosed by a change in serum creatinine of greater than 0.3mg/dL in days to weeks (under 3 months)?
Acute Kidney Injury (AKI)
What is diagnosed by a decrease in GFR (over 3 months duration)?
Chronic Kidney Disease (CKD)
What is an irreverisble loss of renal function that may or may not lead to End Stage Renal Disease (ESRD)?
Chronic Kidney Disease (CKD)
What is an irreversible renal failure of a magnitude that requires renal replacement therapy to survive (dialysis or kidney transplant)?
End Stage Renal Disease (ESRD)
-Creatinine clearance is under 10cc/min
What is azotemia?
Elevation of the BUN (blood urea nitrogen) level
What is BUN?
One of many nitrogen based molecules that accumulates in AKI and CKD and may lead to the development of uremia
What is uremia?
The clinical SE of excess accumulation of nitrogenous compounds (nausea, vomiting, confusion, anorexia)
Under 500 cc of urine output in 24 hours
Greater than 500 cc of urine output in 24 hours
Under 100 cc of urine output in 24 hours
What is oliguric, non-oliguric, and anuric used to describe?
Types of AKI
What is used to assess renal function?
What is an indirect predictor of GFR?
What is used for measured GFR?
24 hour creatinine clearance
What 2 mathematical formulas are used for estimated GFR?
1. Cockroft and Gault
What is serum creatinine (2 things)?
1. End product of muscle metabolism
2. Cyclic anhydride of creatine (nonenzymatic)
Where is creatine made and stored?
-Synthesized in the liver and stored in muscle (CPK)
-Also ingested orally and localized to muscle
What 2 ways is creatinine excreted renally?
1. GFR- Filtration
2. Proximal tubular secretion
So, are creatine and creatinine the same thing?
NOPE...creatine is converted to creatinine (end product of muscle metabolism)
What is CPK?
Creatine phosphokinase (energy source for muscles)
*Can raise serum creatinine level slightly
What pathway is used in the secretion of creatinine in the proximal tubule?
Organic cation secretory pathway
What % of urinary creatinine in healthy patients is from secretion?
In patients with renal disease what is the % of urinary creatinine that is secreted and what is the relevance of this?
30-35% --> Overestimates true function since the blood level of creratinine will be lower than it really should be at any given GFR
What is a normal creatinine level relate to?
What is normal creatinine for women?
Under 1.2 mg/dL (average is 0.95)
What is normal creatinine for men?
Under 1.5 mg/dL (average is 1.15)