[HYHO] HPS Session 2 AKI Flashcards by Jaime Weber

What is the definition of acute kidney injury?

Increase in serum creatinine of greater than or equal to 0.3mg/dL within 48 hours

Urine output of <0.5mL/kg/hour for >6 hours

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What is cardiorenal syndrome?

A condition which therapy to relieve congestive symptoms of HF is LIMITED by a decline in renal funciton

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How is GFR calculated?

Using creatinine

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What is an issue with using creatinine to measure GFR?

Can UNDERESTIMATE the degree of dysfunction

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What are the 3 potential causes for AKI?

Prerenal

Intrinsic

Postrenal

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What are the potential causes of prerenal AKI?

Hypovolemia

Decreased cardiac output

Decreased effetive circulating volume

Impaired renal autoregulation

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What are the causes of intrinsic AKI?

Glomerular

Tubules/Interstitum

Vascular

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What are the causes of postrenal AKI?

OBSTRUCTION

(e.g. bladder outlet obstruction, pelvourethral obstruction)

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What is key to determining the source of an AKI?

Careful history taking

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What is a common example of an event in the hx. of a patient that can present with AKI?

Exposure to IV contrast

Typically increases serum creatinine (25-50%) after administration

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Describe what the symptom correlates with:

Blue toes

Possible cholesterol emboli

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Describe what the symptom correlates with:

Appearance of ‘drug rash’

Acute Interstitial Nephritis (AIN)

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Describe what the symptom correlates with:

Signs of volume contraction (tachycardia, skin tenting, dry oral mucosa, etc…)

Dehydration

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Describe what the symptom correlates with:

Jaundice and ascites

Liver disease with portal hypertension

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What are the symptoms/signs associated with AKI?

Decreased urine output

Worsening dyspea

Orthopnea

Paroxysmal nocturnal dyspnea

Worsening edema

S3 gallop

Hypotension

JVD

Liver distention

Distended abdomen (fluid wave)

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Where is skin testing best evaluated?

Skin of the forehead

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What is paroxysmal nocturnal dyspnea (PND)?

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Episodes of sudden dyspnea and orthopnea that awaken patient from sleep,

prompting patient to sit up or stand up

What is anasarca?

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Severe generalized edema that extrends from the lower extremity proximally

What is a fluid wave?

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Detects large volumes of free abdominal fluid

How would you perform a fluid wave exam?

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Patient places ulnar surface of their hand along the abdominal vertical midline
Physician places one hands on one flank and taps gently on the opposite flank
( + ) sign = physician feels a fluid wave emanating into the contralateral side

What is puddle sign?

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Lower sensitivity than fluid wave detection, also…it’s really awkward.

Literally. Look at the image. You make your patient assume the position.

This is an auscultatory percussion sign, pt. holds this position on their hands and knees for 5 min. The physician then listens with stethescope while flicking a finger over a localized flank area of the abdomen.

(+) sign= increase in intensity and clarity of sound

Osteopathic structural exam (OSE)

Levels: Kidney

Sympathetic?

Parasympathetic?

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Sympathetic = T10-T11

Parasympathetic = Vagus nerve

Osteopathic structural exam (OSE)

Levels: Upper ureters

Sympathetic?

Parasympathetic?

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Sympathetic = T10-11

Parasympathetic = Vagus nerve

Osteopathic structural exam (OSE)

Levels: Lower ureters

Sympathetic?

Parasympathetic?

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Sympathetic = T12-L2

Parasympathetics= Pelvic splanchnic nerve

Osteopathic structural exam (OSE) Levels: **Bladder** Sympathetic? Parasympathetic?

Sympathetic = T12 - L2 Parasympathetics = Pelvic splanchnic nerve

Where are the (dare I say) chapman points for the **kidney?** Anterior/posterior?

Anterior = One inch **lateral** and one inch **superior** to the **umbilicus** Posterior = Between the **transverse process** of **T12** and **L1**

_5 model approach_ What are the considerations you would make for AKI with... **Biomechanical?**

SD of **OA, AA** SD of **thoracic spine** at viscerosomatic levels (T10-11) SD of the **psoas muscles**

_5 model approach_ What are the considerations you would make for AKI with... **Respiratory/Circulatory**

O2 via mask/nasal canula Lymphatics: (Thoracic inlet MFR, diaphragms, Thoracic area [pectoral traction, doming the diaphragm, thoracic pump], Abdominal area [abdominal pump, sacral rocking, pelvic diaphragm], Extremities [effleurage, petrissage, pedal pump], Rib raising)

_5 model approach_ What are the considerations you would make for AKI with... **Neurologic?**

Consider the sympathetics and parasympathetics of: --\> Kidneys, ureters (upper and lower), bladder --\> Chapman points --\> Rib raising treatment

_5 model approach_ What are the considerations you would make for AKI with... **Metabolic/Erergetic/Immune?**

Loop diuretics Fluid restriction Remove offending agents (NSAIDS, PPI) Adjust meds based on renal function Monitor I/O's, weights

_5 model approach_ What are the considerations you would make for AKI with... **Behavioral?**

Exercise Diet --- restrict fluids, decrease salt intake Avoid offending agents Better management of CHF

What are the (4) mechanisms to account for **AKI** in conjunction with **AHF?**

Neurohormonal adaptations Reduced renal perfusion Increased renal venous pressure Associations with heart failure with preserved ejection fraction (HFpEF)

What are the (9) possible treatment options for **AKI?**

1. Remove offending agents (NSAIDS, PPI, etc) 2. Loop diuretics 3. Adjust medications 4. Supportive care = oxygen 5. Monitor weight 6. Fluid restriction 7. Monitor electrolytes 8. Case management/manager 9. Dietary consult

What is the MAJOR drug used in the treatment of AKI?

Loop diuretics (furosemide)

What type of diuretics should be avoided in treating AKI?

K+ sparing diuretics (they will complicate K+ management)

What is a **living will?**

Summarizes choices about *_future medical care_* (typically addresses **resuscitation** and **life support**)

What is a **durable power of attorney for healthcare (DPAHC)?**

Authorizes another person (or surrogate) to make decisions on the patient's behalf

If a patient has elected some restriction in their living will (do not resuscitate, do not intubate, etc), the physican MUST???

**DOCUMENT** the order appropriately. The presence of the living wil alone will NOT prevent resuscitation

What is the **KDIGO** criteria?

KDIGO = Kidney Disease Improving Global Outcomes It is a set of criteria used to "stage" the level of kidney disease

What is **STAGE 1** of **KDIGO?**

Increase in serum creatinine of greater than or equal to **0.3mg/dL** / **50 to 99%** increase OR Urine output of **\<0.5 mL/kg/hour** for **6** to **12** hours

What is **STAGE 2** of **KDIGO?**

Increase in serum creatinine of **100** to **199%** of normal OR Urine output of **\<0.5 mL/kg/hour** for **12** to **24 hours**

What is **STAGE 3** of **KDIGO?**

Increase in serum creatinine of **\>220%** of normal OR Urine output of **\<0.3 mL**/kg/hour for more than **24 hours** OR **Anuria** for greater than **12 hours** OR Initiation of **renal replacement therapy**

[HYHO] HPS Session 2 AKI Flashcards

(42 cards)