Acute Kidney Injury III

Question 1

Presentation:

male in emergency department: GFR 93ml/min to 23ml/min. Vague symptoms with decreased appetitude. What tests do you need?

Answer 1

• Urine sodium (random; look for thirsty kidney– pre renal)
• Urinalysis/Microscopy (renal cause of AKI- dysmorphic blood,, any casts, proteinuria)
• Proteinuria Quantification (ACR)
• CBC (signs of MAHA)
• Ultrasound (post renal to r/o obstruction)
• Consider foley catheter.
• Consider electrolyte panel to ensure no acidosis

Question 2

urine sodium is <20 mmol/L but everything is normal. What type of AKI is this?

Answer 2

pre-renal AKI. Must find out why he has a low EABV in the first place/reduced kidney blood flow.

it is very rarely caused by just not drinking a lot fluid.

Question 3

this person shows up with a GFR that fell from 95 to 15. these are her labs. What do you think the cause is of her AKI?

Answer 3

she has dysmorphic RBS and casts and protein. probably a REANAL AKI – could be glomerular damage, tubular, vascular, interstitial damage.

GLOMERULAR NEPHRITIS– but must figure out which disease is causing the GN

Question 4

63 y/o man comes in with general malaise. GFR drops form 76 to 17ml/min. hisotry vague and no clear precipitants

Answer 4

He has blood in his urine. His protein is also high. He has hydronephrosis. It’s isomorphic tehrefore not RBC not coming from glomerulus, but from lower in the urinary tract.

this guy has post renal AKI from BPH

Question 5

Question 6

Management of AKI;

kidneys may lose the ability to maintian body homeostasis. there are 5 main areas we focus on when someone has AKI:

1. drug toxicity
2. vol overload
3. electrolyte distrubances.
4. acidosis
5. uremia.

two major concerns with drugs:

Answer 6

1 neprhotoxicity- drug clearance.

• reduction in kidney function may raise the elvels of the drug inthe body, leading to toxicity.
• when we see AKI, it’s crucuial that we do a thorough review of medications.
  2. medication overdosing.

ex/ NSAIDS

Question 7

kidneys with AKI lose the ability to __ volume. volume ___ is the biggeste risk. Must monitor __ and __ intake and treat with __.

Answer 7

kidneys with AKI lose the ability to regulate volume. volume overload is the biggeste risk. Must monitor water and salt intake and treat with diuretics

People with AKI often have a fixed amount of Na and water excretion per day and is not flexible. we need to carefully watch volume status, must keep them euvolemic.

Question 9

the kidneys regulate a number of electrolytes, which make any electrolyte susceptible to being deranged. the most common and worrisome are instances of __ and ___.

Answer 9

the kidneys regulate a number of electrolytes, which make any electrolyte susceptible to being deranged. the most common and worrisome are instances of hyperkalemia and acidosis.

to treat hyperkalemia, you need to reduce potassium intake and may need diuretics, binders or hemodialysis.

to treat acidosis, you might need to give oral or IV sodium bicarbonate.

Question 10

to treat hyperkalemia, you need to reduce __ intake and may need __, __ or __.

to treat acidosis, you might need to give oral or IV sodium ___.

Answer 10

to treat hyperkalemia, you need to reduce potassium intake and may need diuretics, binders or hemodialysis.

to treat acidosis, you might need to give oral or IV sodium bicarbonate.

Question 11

uremia

Answer 11

symptoms due to toxin build up. Urea is not necessarily the cause of the uremia. can be a number of chemicals

Question 12

common and extreme symptoms of uremia

Answer 12

nausea, low energy, metallic taste, ithcing, trouble sleeping, GI upset.

Serious complications include uremic pericarditis (can lead to tamponade) and decresed LOC

Question 13

two treatments in the management of uremic syndrome

Answer 13

1. reverse the kideny injury
2. emergency dialysis.