AKI

Question 1

name three things the kidney regulates?

Answer 1

pH via recreation and reabsorption of HCO3-
Osmolarity
Blood presssure

Question 2

what does the kidney maintain?

Answer 2

ion balence

Na+ K+ ca2+ and HCl

Question 3

what does the kidney excrete?

Answer 3

urea , creatinine, drugs , urobilinogen and hormones

Question 4

what hormones does the kidney produce?

Answer 4

vitamin D3 and erythropoetin

Question 5

how do you calculate the amount of solute excreted?

Answer 5

amount filtered - ( amount absorbed + amount secreted )

Question 6

why is creating a useful indicator of eGFR?

Answer 6

It undergoes glomerular filtration in the kidneys and very little is reabsorbed. mainly excreted so useful indicator

Question 7

what are two advantages of the Cockcroft and gault calc ?

Answer 7

• easy to calculate on practise

- used for many years and so used in spa as a refernece

Question 8

what are two disadvantages of the Cockcroft and gault calc ?

Answer 8

• body weight isn’t an accurate measure of muscle mass so it cannot be used if a patient is obese
• the calc is used on variable limits

Question 9

what is an advantage of the MRDR equation?

Answer 9

a better estimation than cockcraft and Gault

Question 10

what is an disadvantage of the MRDR equation?

Answer 10

Harder to calculate in practise

docent take into account the patients body mass

Question 11

what is a negative of the CKD-EPI?

Answer 11

very complex to calculate

Question 12

how does an AKI affect fluid balance?

Answer 12

oedema ( swollen legs) and pulmonary oedema can develop

diuretics may be needed

Question 13

how does an AKI affect acid balance?

Answer 13

when a patient has pulmonary oedema and respiratory compensation acidity in the blood increases which can lead to hyper ventilation

Sodium retention increases leading to seizures and thirst

Question 14

how does an AKI affect electrolyte balance?

Answer 14

electrolyte balance becomes disturbed which can cause arrithhymias , muscle weakness and paralyis.

Question 15

what happens to endocrine function in an AKI

Answer 15

erythropoetin production can be reduced leading to anemia this is more common in CKD than an AKI

vitamin d activation is reduced leading to an increased risk of fractures

renin agiotensin system is reduced leading to calcification in blood vessles and an increased cardiovascular risk

Question 16

how does an AKI affect excretion?

Answer 16

patient has reduced excretion of

• water soluble substances leading to pruritus , itching cramping and restless leg syndrome
• waste products leading to nausea and toxicity and due to increased acidity ulcers
• medication leading to drug toxicity

Question 17

what is an AKI?

Answer 17

a sudden decline in kidney function over hours or days , not a disease or a physical injury

Question 18

why does acidosis happen during an AKI ?

Answer 18

as there is disruption of acid base balance

Question 19

why doses oedema happen during an AKI?

Answer 19

disruption of the fluid balance

Question 20

why do cardiac arrhythmias , muscle weakness and paralysis occur during an AKI?

Answer 20

disruption go the regulation of electrolytes which causes hyperkalemia

Question 21

what are the pre renal causes of an AKI ?

Answer 21

hypo-perfusion
kidney cells being killed
acute tubular necrosis
blood going into the kidney and having a low bp

Question 22

what are the renal causes of an AKI ?

Answer 22

intrinsic renal disease

Question 23

what are the post renal causes of an AKI?

Answer 23

obstruction something is blocking urine output

Question 24

what are the causes of kidney failure?

Answer 24

pyelonephritis , hypertension, diabetes mellitus , nephrotoxic drugs ,hypoyvelemia and nephroallergens

Question 25

how can phylonephriitis cause an AKI?

Answer 25

it is inflammation and detonation of the phenols due to infection antigens

Question 26

how can hypertension cause an AKI?

Answer 26

chronic overloading of the kidney with fluid and electrolytes may lead to kidney insufficiency and failure.

Question 27

how can diabetes cause an AKI?

Answer 27

disturbance of sugar and the acid base balance may lead to renal disease

Question 28

how can nephrotoxic drugs cause an AKI?

Answer 28

some dugs taken chronically can cause irreversible kidney damage

Question 29

how can hypovelemia cause an AKI?

Answer 29

reduction in renal blood flow will lead to schema and damage

Question 30

how can nephroloallergens cause an AKI?

Answer 30

some compounds produce an immune reaction type of sensitivity reaction with nephritic syndrome

Question 31

which drugs in particular are nephrotoxic ?

Answer 31

ahminoglycosides , phenacetin and heavy metals.

Question 32

what is uraemia?

Answer 32

it is chronic or acute kidney failure causing impaired glomerular filtration caused by disease or trauma

Question 33

what are the pharmacokinetic considerations ?

Answer 33

``` oral bioavalibility elimination volume of distribution dose considerations total body clearance ```

Question 34

how is oral bioavailability affected in the pk considerations of a uraemia patient?

Answer 34

oral bioavalibility may decrease but drugs with a high first pass effect increase bioavalibility

Question 35

how is elimination affected in the pk considerations of a uraemia patient?

Answer 35

elimination clearance increases which reduces glomerular filtration

Question 36

how is total body clearance affected in the pk considerations of a uraemia patient?

Answer 36

it is reduced

Question 37

how is volume of distribution affected in the pk considerations of a uraemia patient?

Answer 37

-protein binding decreases so the amount of free unbound drug increases - accumulation of metabolites decreases especially weak bases -changes in total body water Overall Vd increases

Question 38

what is dialysis?

Answer 38

the diffusion of molecules from the patients blood into the dialysis fluid through a membrane until an equilibrium, can be reached

Question 39

what are the factors affecting dialyisis?

Answer 39

protein binding molecular weight volume of distributon water soluble

Question 40

how does water solubility affect dialysis ?

Answer 40

drugs that are fat soluble are not dialysis

Question 41

what is peritoneal dialysis?

Answer 41

filters through the patients own peritoneal membrane in there abdomen

Question 42

what is haemodialysis ?

Answer 42

uses an artificial membrane to filter through

Question 43

how does molecular weight affect dialysis ?

Answer 43

drugs under 500 MW are dialysed easily

Question 44

how does protein binding affect dialysis ?

Answer 44

drugs that are tightly bound to proteins aren't dialyses easily as dialysis is a passive process

Question 45

how does volume of distribution affect dialysis ?

Answer 45

drugs that have a volume of distribution take longer to be hydrolysed

Question 46

what is hemoperfusion?

Answer 46

when the blood passes through an absorbent material and goes back into the patients body

Question 47

what is haemofiltration

Answer 47

when fluids electrolytes , small molecules are removed from the body by low pressure flow through hollow artificial fibres