Renal 2 (Week 13) Flashcards Preview

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Flashcards in Renal 2 (Week 13) Deck (47):
1

What causes prerenal AKI

reduced blood perfusion of kidney

2

what causes reduced blood perfusion to kidneys

arterial hypotension
dehydration
sepsis
arterial occlusion (plaques, air bubbles, fat globules)
administration of ACE inhibitors or ARB meds

3

what do NSAIDs do

inhibit production of all types of prostaglandins

4

intrinsic AKI

damage to structures within the kidney

5

most common cause of intrinsic AKI

acute tubular necrosis

6

what causes acute tubular necrosis

renal ischemia
shock syndrome

7

causes of intrinsic AKI

acute tubular necrosis
exposure to toxins such as
-myoglobin
-contrast dyes
-aminoglycosides
-infections (TSS)
- auroimmunity
-other pharmaceuticals

8

postrenal AKI due to

obstruction of flow in urinary system

9

causes of postrenal AKI

prosttatic hypertrophy or cancer
infection
improperly placed urinary catheter
nephrolithiasis (kidney stone)

10

primary means to determine presence of AKI

serum creatinine
urine output

11

other tests used to detect AKI

urine sedimentation
urine osmolality and electrolytes
serum electrolytes
urinary specific gravity
microscopic eval of urine
blood urea nitrogen

12

what would you look for in microscopic eval of urine

bacteria
pieces of dead cells
-indicates infection or breakdown of cells (usually renal tubular cells)

13

blood urea nitrogen more useful for

monitoring chronic kidney disease

14

what happens as BUN levels increase above normal?

GFR decreases below normal

15

albuminuria

albumin (protein) in urine

16

how is chronic kidney disease defined (CKD)

abnormalities in kidney structure or function present for 3 months or longer

17

structural abnormalities seen in chronic kidney disease

albumuria
hemaaturia
presence of red cell casts
electrolyte abnormalities

18

what indicates a functional abnormality in CKD

drop in GFR

19

Biggest risk factor for CKD

diabetes

20

other risk factors for CKD

hypertension
60 y/o or greater

21

prognosis of CKD determined by

-cause of kidney disease
-GFR at diagnosis
-degree of albuminuria
-presence of other pathologies

22

what cause of kidney disease would yield a poor prognosis

autoimmune process

23

(increased/decreased) GFR at diagnosis yields a poor prognosis in CKD

decreased

24

(increased/decreased) albuminuria yields a poor prognosis in CKD

increased

25

what comorbid pathologies would yield a poor prognosis in CKD

diabetes
high BP
pulmonary disease
autoimmune disorders

26

what does KDOQI stand for

Kidney Disease Outcome Quality Initiative

27

what does the KDOQI categorize

categorizes CKD into categories based on GFR

28

(higher/lower) KDOQI level indicates worse prognosis

higher

29

how is hypertension related to CKD

-can cause or be a result of CKD
-retaining water and sodium
-derangements of angiotensin system

30

what does proteinuria have a direct proportion to?

risk of cardiovascular disease

31

nicotine causes vaso(constriction/dilation)

vasoconstriction

32

what does smoking do in relation to CKD

reduces GFR
increases BP
increases urinary albumin excretion

33

what does cigarette pack years help predict

how fast CKD will progress

34

hos is pack years calculated

packs per day x # years smoker

35

what is the relationship between smoking and CKD

obesity increases risk of G5 CKD

36

what does CKD progress into after several years

end stage renal disease

37

what type of tx are patients typically undergoing at ESRD

dialysis (or being considered)

38

what causes CKD to progress into ESRD

-ongoing loss of nephron mass
-glomerular capillary hypertension
-proteinuria

39

what happens with glomerular capillary hypertension

hypertrophy of remaining glomeruli; pores get larger; more protein goes through pores leading to proteinuria

40

what does erythropoietin do

secreted by kidney; acts on marrow to produce RBC

41

how is CKD related to anemia

decreased production and secretion of erythropoietin occurs due to damage and loss within kidney

42

what stage of CKD is anemia typically present

C3a and beyond

43

how is CKD related to osteoporosis

decreased elimination of phosphorus which leads to hyperphosphatemia and a decrease in calcium levels.
decreased conversion of vitamin D into its active form so less calcium absorption in gut

44

what happens in CKD in relation to acid base balance

CKD interferes with acid-base balance; CKD patients are acidotic

45

medical treatment for CKD

control acid/base balance
control electrolyte imbalances
antihypertensive medications (ACE inhibitors, ARBs)

46

how are electrolyte imbalances controlled in CKD

dietary restriction
-limit potassium, sodium, or water intake

47

Therapeutic treatment of CKD

diet- protein restriction, sodium restriction (elevated sodium increases BP and proteinuria)
exercise- achieve and maintain healthy BMI
smoking cessation- slows progression of CKD
pharmaceuticals- diuretics; treat sx/problems