AKI + congenital/stricture disorders Flashcards
(36 cards)
Increased BP, failure of fluid homeostasis, accumulation of waste productions → N/V, malaise, AMS, pericarditis/pericardial effusion
Symptoms due to underlying problem
Severe = arrhythmias (hyperkalemia), platelet dysfunction, neuro changes
AKI
failure of excretion, acid/base disturbance, electrolyte imbalance
renal/tubular problem
patient unable to pee, pain
postrenal
what are RF for AKI?
NSAID use, diuretics
Rapid increase in serum Cr → rapid loss of kidney function
AKI
normal Cr
Men .7-1.3
Women .6-1.1
Initiation → anuric/oliguric (kidneys working to concentrate urine) → diuretic (urine no longer concentrated, body is losing water) → recovery
AKI
MC: hypoperfusion, dehydration, shock, clot, liver, meds, heart (cardiorenal syndrome, often from sepsis), vasoconstriction, HOTN
prerenal AKI
glomerulus (nephritic, nephrotic), tubule (ATN), interstitium (AIN) from prolonged prerenal azotemia, radiocontrast dye, AGs, vancomycin
renal AKI
obstruction (prostate, neurogenic bladder, retroperitoneal fibrosis, kidney stone, tumors, urinary retention meds)
postrenal AKI
What are the three diagnostic tools you could use with AKI?
Cr increase of >/= .3 mg/dL in 48 hours
Cr 1.5x baseline in 7 days
UO <.5 ml/kg/6 hours
Elevated Cr, metabolic acidosis, hyperkalemia, hypocalcemia, hyperphosphatemia, anemia, prolonged bleeding time
AKI
low sodium, increased osmolality, increased specific gravity, FeNA <1% (if on diuretics, FeUrea <35%)
BUN:Cr = >20:1 (BUN has risen)
prerenal AKI
rule out pre/post renal – urine abnormalities with Cr increase, urine osmo lower than normal, same as plasma, increased sodium, muddy brown casts
BUN:Cr = <20:1 (Cr has risen as well, with ratio normal, but both elevated)
renal AKI
US → distended bladder, kidneys, ureter
BUN:Cr not helpful
>Cr = bilateral kidney involvement
US most beneficial for this type
postrenal AKI
stages of AKI
Stage I: 1.5-1.9 fold increase in Cr or decline in UO to <.5 ml/kg/hr over 6-12 hours
Stage II: 2-2.9 increase in Cr or decline to <.5 ml/kg/hour over 12 hours or longer
Stage III: 3x greater Cr or increase to >/= 4 or decline in UO <.3 for 24+ hours or anuria for 12+ hours or initiation of kidney replacement therapy
How do you treat AKI?
Prerenal: Volume repletion to restore volume + renal perfusion
– return of Cr to previous baseline w/n 24-72 hours is considered correction
Renal: remove offending agent/s and IV fluids first line
Postrenal: remove obstruction
Asymptomatic and often found incidentally
May have: UTIs, vesicoureteral reflux (retro flow of urine from bladder into upper urinary tract often in children which can cause lots of complications), ureteropelvic junction obstruction is most common, nephrolithiasis, malignancies, trauma
→ increased risk for pyelonephritis and kidney stone formation, renal carcinoma
horseshoe kidney
Lower poles of kidneys fused together (connected = isthmus)
Embryological abnormality – IMA hooks over isthmus and they do not ascend properly
Higher incidence with other congenital syndromes, teratogenic drugs (thalidomide), alcohol consumption, poor glycemic control
horseshoe kidney
Can be diagnosed on routine fetal US – suspect in those with hydronephrosis in infancy, abdominal mass, any complications indicating renal abnormality
* US or CT
CT and MRI best for anatomy + structures
CT urogram for stones and urinary blockages, UPJ
MRI for diminished renal function
horseshoe kidney
voiding cystourethrogram and radionuclide cystogram is best to diagnose
Vesicoureteral reflux
How do you treat horseshoe kidney?
Mostly no treatment needed
Vesicoureteral reflux = prophylactic antibiotics to prevent UTI
Treat obstruction, stones, infection as needed
Pain in side and back/flank, abdomen, groin, painful urination, increased/decreased urinary frequency, incomplete urination, incontinence
Acute renal failure + anuria = bilateral
hydronephrosis
Enlargement of renal pelvis due to build-up of urine (generally to UTO), dilation of collecting system
MCC = BPH
Cancer, stones
Unilateral = blockage occurs above the bladder
Bilateral = blockage at or below the bladder
Can also be from congenital abnormalities, blood clot, scarring, pregnancy, UTI
hydronephrosis