acute kidney injury (W3)

Question 1

ischemic injury

Answer 1

1. related to volume depletion and decreased perfusion
2. toxic injury from chemicals
3. sepsis

Question 2

injury initiates

Answer 2

inflammatory response, vascular response, cell death

Question 3

3 classes for AKI

Answer 3

1. pre-renal
2. intra-renal
3. post-renal

Question 4

pre-renal

Answer 4

before the kidneys!

most common cause is inadequate perfusion

hypotension, hypovolemia, sepsis, inadequate CO, renal vasoconstriction, renal artery stenosis

decreased GFR due to low glomerular filtration pressure

failure to restore blood volume, blood pressure, and oxygen delivery can cause ischemic cell injury and necrosis

Question 5

intra-renal

Answer 5

most common cause is acute tubular necrosis (ATN)

related to pre-renal AKI, nephrotoxic agents, acute glomerulonephritis, vascular disease

pre-renal AKI can become intra-renal AKI

hypotension and hypovolemia cause ischemia and inflammatory response in kidney

cause of nephrotoxic acute tubular necrosis: antibiotics, exposure to heavy metals, contrast dye, rhabdomyolysis

Question 6

post-renal

Answer 6

rare, usually occurs with urinary tract obstruction

causes: bladder outlet obstruction, prostatic hyperplasia, bilateral urethral obstruction, tumor, neurogenic bladder

Question 7

acute kidney injury

Answer 7

sudden decline in function and rapidly progressive

decreased GFR (< 90 ml/min)
decreased UOP (> 30 ml/min)
increased BUN (10-20 mg/dl)
increased creatinine (0.5-1.2 mg/dl)
*normal in parenthesis

may be reversible

Question 8

clinical manifestations of AKI

Answer 8

oliguria, < 400 ml/24 hours
begins 1 day after hypotensive event and lasts 1-3 weeks

Question 9

AKI pharm treatment

Answer 9

goal to stabilize the patient until kidney function is returned

correct electrolyte imbalance
1. lasix to push kidneys to function and removed potassium
2. dectrose and insulin to help move potassium back into cells
3. binders- sodium potassium sulfonate, patriomer, sodiumzicanium cyclosilicate

correct acid-base imbalance (metabolic acidosis) with sodium bicarbonate

manage BP

avoid nephrotoxic drugs