Exam 2 - Acute Kidney injury and chronic kidney disease

Question 1

Kidney Function

Answer 1

maintain fluid and electrolyte homeostasis
rid the body of water soluble wastes via urine

Question 2

three important endocrine function of kidney

Answer 2

produce erythropoietin - stimulate RBC production
activates vitamin D
Produces renin, which helps regulate BP

Question 3

Kidney injury

Answer 3

Kidneys are needy - lots of blood flow
Kidney injury can happen suddenly and progress rapidly, but it is reversible.
Renal insufficiency - 25% of normal GFR - indicator of kidney injury is less than 90.

Question 4

Acute Kidney Injury
Usually result
Common cause
Kidney function

Answer 4

usually the result of ischemic injury related to loss of volume - decreased perfusion.
Toxins or sepsis common causes

Kidney function can be mildly affected to severe

Question 5

AKI classifications - 3

Answer 5

depends on WHERE
pre-renal - volume loss related
intrarenal - acute tubular necrosis (chemical and kidney cell death)
post-renal - not as common, obstruction causes cell death

Question 6

AKI Clinical manifestations

Answer 6

Oligurial - less than 400 ml/24H
Begins one day after hypotensive event and lasts 1-3 weeks
Fluid volume excess (edema)
Metabolic acidosis
Hyponatremia
Hypokalemia
Waste product accumulate
Neurologic disorders

Question 7

Stage 1 Kidney Disease

Answer 7

Asymptomatic

Question 8

Stage 2 Kidney Disease

Answer 8

Asymptomatic, possible HTN

Question 9

Kidney failure

Answer 9

Uremic - urea in blood

Question 10

Best way to treat Kidney injury?

Answer 10

Prevent!

Question 11

Causes of ESRD

Answer 11

Diabetes 50%
Glomerulo-nephritis 10%
HTN 30%
Other 10%

Question 12

Risk factors for CKD - 8

Answer 12

Family History
Increasing age >60
Male
Black
HTN, DM, smoking
Overweight/obesity

Question 13

Renal Injury

Answer 13

Cyclical Problem
Biggest indicator is proteinuria at nephron level.
Also Increase in Angiotensin 2

Question 14

CKD Cardiovascular Manifestations

Answer 14

Hypertension
Heart failure
Coronary artery disease
Pericarditis
Peripheral artery disease

Question 15

CDK Gi manifestations

Answer 15

Anorexia
nausea
vomiting
gi bleeding
gastritis

Question 16

CKI neurologic manifestations

Answer 16

fatigue
headache
sleep disturbances
encephalopathy

Question 17

CKI integument manifestations

Answer 17

pruritus
ecchymosis
Dry, scaly skin

Question 18

CKI pulmonary manifestations

Answer 18

PULMONARY EDEMA!!
uremic pleuritis
pneumonia

Question 19

If Kidneys no longer maintain F & E homeostasis then

Answer 19

Edema, hyperkalemia, hyperphosphatemia, hypermagnesemia, metabolic acidosis

Question 20

If kidneys no longer rid the body of wastes via urine then

Answer 20

ANOREXIA, malnutrition, itching, CNS changes

Question 21

If kidneys decrease production of erythropoietin

Answer 21

Anemia (5-6)

Question 22

If kidneys decrease activation of vitamin D

Answer 22

renal osteodystrophy (weakened bone)

Question 23

Slowing the progression of CKD

Answer 23

Blood pressure control (110-130) – ACE or ARBs
Lipid control – statins

Question 24

For volume overload

Answer 24

Loop Diuretic with low salt diet

Question 25

For hyperkalemia

Answer 25

multiple drugs addressed with hemodialysis in ESRD

Question 26

for metabolic acidosis

Answer 26

sodium bicarbonate, an alkaline agent

Question 27

for hyperphosphatemia

Answer 27

calcium carbonate, a phosphate binder

Question 28

for renal osteodystrophy

Answer 28

calcitriol, an activated vitamin D

Question 29

for anemia

Answer 29

erythropoietin ** black box warning

Question 30

Sodium bicarbonate

Answer 30

treats metabolic acidosis

Question 31

goal of sodium bicarbonate Slow Prevent Improve

Answer 31

slow progression of SKD prevent bone loss improve nutritional status

Question 32

how is sodium bicarbonate given

Answer 32

PO

Question 33

When do you give sodium bicarbonate

Answer 33

When HCO3 is less than 15 mEq/mL -- goal is 18-20

Question 34

side effect of sodium bicarbonate

Answer 34

bloating

Question 35

Calcium carbonate

Answer 35

to treat hyperphosphatemia

Question 36

Moa of calcium carbonate

Answer 36

binds to phosphate

Question 37

goal of calcium carbonate

Answer 37

keep normal phosphate levels, decrease mortality

Question 38

how to take calcium carbonate

Answer 38

take with meals

Question 39

adverse effect of calcium carbonate

Answer 39

hypercalcemia -- monitor calcium

Question 40

calcitriol

Answer 40

vitamin D

Question 41

what does calcitriol do

Answer 41

treat renal osteodystrophy

Question 42

moa of calcitriol

Answer 42

activated form of vitamin D. stimulates intestinal absorption of calcium/phosphate and bone mineralization

Question 43

adverse effects of calcitriol

Answer 43

hypercalcemia, hyperphosphatemia

Question 44

complications of drug therapy

Answer 44

drugs are excreted through kidneys. Monitor drug levels because they may need to be changed.

Question 45

Drugs of particular concern

Answer 45

Digoxin Diabetic agents (glyburide, metformin) Antibiotics (vancomycin) Opioids (morphine) **** opioids especially because of respiratory depression.