B.1 Flashcards
(36 cards)
characteristics of AKI
- sudden loss of renal function –> decrease GFR within hrs/days)
–>increase createnine
–>increase BUN - decrease urine output –> oliguria
- Acid-Base disturbances
- electrolytes disturbances
- impaired urinary execretion of drugs
Etiology of AKI
- prerenal: most common (decrease renal perfusion)
- Renal: Glomerular, Tubular, Interstitia, Vascular
- PostRenal: obstruction
PreRenal pathophys. background
- shock
- IAH
- RA thrombosis
Renal pathophys. background
- Glomerulonephritis
- pyelonephritis
- vasculitis
- nephrotoxins
- HTN
- Amyloidosis
PostRenal pathophys background
- BPH
- malignancy
- stones
consiquences of AKI?
(10)
volume overload
metabolic acidosis
electrolytes
pulmonary edema
acute lung injury
uremia
immune system
hematological
GI edema
pharmacological
consiquences of AKI related to VOLUME?
- CHF
- HTN
- decreased perfusion
consiquences of AKI related to metabolic acidosis?
- Hypercholermia
- Accumulation of organic ions (PO4)
- decrease Albumin –> buffer
- impaired insulin action –> hyperglycemia
- catecholamine resistance
consiquences of AKI related to electrolyte disturbances?
- hyperkalemia
- hyponatremia
consiquences of AKI related to pulmonary edema?
due to low albumin
consiquences of AKI related to uremia?
decreased GFR
consiquences of AKI related to immune syst?
- ROS clearance decreased
- WBC function decrease
- infection risk increase|
- T.edema
consiquences of AKI related to Hematological?
- decrease EPO –> anemia
- decreased vWF –> bleeding
- increased RBC destruction
consiquences of AKI related to GI edema?
- compartment syndrome
- decreased nutritional absorption
- gut ischemia
ALL lead to –> peptic ulcer
consiquences of AKI related to pharmacological?
decreased bioavailability
decreased elemination
decreased albumin
all lead to –> under-dosing or toxicity
AKI in ICU?
25-70% AKI
15-60% increased mortality
no causual therapy but replacement therapy is possible
how do you diagnose AKI?
physical signs:
- decrease BP
- decrease turgor
- tachycardia
- edema: if HF and cirrhosis
Lab:
- decrease URINE Na <20mmol/L
- increase urine osmolarity > 500mOsm/L
- increase urine specific gravity > 1020
- increase urea in serum –> BUN>creatinine
- neg. urinary sediment
RIFLE criteria in AKI?
Risk
Injury
Failure
Loss of function
ESRD (end stage renal disease)
what are the I criteria in AKI?
I= injury
- createnine criteria: 2-9x baseline
- Urine output: < 0.5ml/kg/hr for >12h
what are the R criteria in AKI?
R = at risk
- createnine criteria: 1.5-1.9x increase in createnine within 7 days
- Urine output: < 0.5ml/kg/hr for 6-12h
what RIFLE criteria is based on?
- acute increase in serum createnine
- acute decrease in Renal output
what are the F criteria in AKI?
F= failure
- createnine criteria: 3x baseline
- Urine output: < 0.3ml/kg/hr for >24h or Anuria for 12hr
what is the L criteria in AKI
L= loss of function
complete loss of renal function >4w
supportive AKI management?
avoidance
- nephrotoxic
- contrast studies
