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Urinary Exam 1 > Renal Physiology and AKI (Week 3): AKI Pathophysiology, Fluid Therapy, Potassium > Flashcards

Renal Physiology and AKI (Week 3): AKI Pathophysiology, Fluid Therapy, Potassium Flashcards

1
Q

On what side of the cell is the NaK-ATPase pump?

A

Basolateral side of the cell, next to the basement membrane

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2
Q

What causes the cells to swell?

A

the accumulation of sodium

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3
Q

What do we call cells that detach and accumulate enough to clog the lumen such that ultrafiltrate can’t drain out to the bladder and show up in the urine?

A

Cellular Casts

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4
Q

What are the vasodilatory substances?

A

PGE2, prostacyclin, and nitric oxide

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5
Q

What leads to leaky vessels?

A

When AKI causes an increase in vascular permeability

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6
Q

With AKI. the balance is tipped more towards _______________ substances leading to Intrarenal Ischemia and and decreased oxygen

A

Vasoconstrictive

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7
Q

inadequate blood supply to an organ

A

ischemia

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8
Q

Luna has an increased creatinine, so she is NOT maintaining adequate excretory function. How would you characterize Luna’s lab values?

A

Pre-renal Azotemia

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9
Q

What are you thinking of for a fluid plan (3 things)?

A
  • Correcting dehydration
  • Providing fluids for daily living
  • Replacing on-going losses
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10
Q

How to correct dehydration?

A
  • Estimate dehydration
  • Calculate fluid deficit (%dry x kg)
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11
Q

Physical Findings In Dehydration:
Not detectable

A

<5%

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12
Q

Physical Findings In Dehydration:
Subtle loss of skin elasticity

A

5-6%

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13
Q

Physical Findings In Dehydration:
- Definite delay in return of skin to normal position
- Slight prolongation of capillary refill time
- Eyes possibly sunken in orbits
- Possibly dry mucous membranes

A

6-8%

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14
Q

Physical Findings In Dehydration:
- Tented skin stands in place
- Definite prolongation of capillary refill time
- Eyes sunken in orbits
- Dry mucous membranes
- Possibly signs of shock (tachycardia, cool extremities, rapid and weak pulses)

A

10-12%

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15
Q

Physical Findings In Dehydration:
- Definite signs of shock
- Death imminent

A

12-15%

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16
Q

“Maintenance” fluid therapy, commonly regarded to be about ________________, presumes “normal” urine output without excessive losses (i.e., vomiting, diarrhea)

A

66 mL/kg/day

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17
Q

Maintenance Fluid Rates
- A variety of formulas have been published:

A
  • 66 ml/kg/day
  • 50-60 ml/kg/day (DOGS)
  • 40-50 ml/kg/day (CATS)
  • 40 ml/kg/day (LARGE DOGS)
  • 60 ml/kg/day (SMALL DOGS, CATS)
  • 140 x body weight^0.75 (DOGS)
  • 80 x body weight^0.75 (CATS)
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18
Q

The main fluid output is in urine and in respiratory loss which is called _______________, because we can’t easily measure it

A

insensible

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19
Q

Respiratory loss:
Average =

A

22 ml/kg/day

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20
Q

Loss in normal feces =

A

generally ignored (diarrhea is a
different story!)

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21
Q

Normal GFR is

A

4 ml/kg/MIN

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22
Q

Animals are about _______ water

A

60%

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23
Q

Dogs have about _____
ml/kg of blood

A

90

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24
Q

Urine Volume (ml/kg/hr):
Anuria

A

< 0.05

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25
Q

Urine Volume (ml/kg/hr):
Oliguria

A

< 0.5

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26
Q

Urine Volume (ml/kg/hr):
Nonoliguria

A

0.5 - 2

27
Q

Urine Volume (ml/kg/hr):
Polyuria

A

> 2

28
Q

kg =

A

L

29
Q

g =

A

mL

30
Q

What is less common than vomiting with AKI, but can represent substantial fluid losses in these patients?

A

Diarrhea

31
Q

Weight goes up with fluid gain, blood pressure goes up with fluid gain, but what go down with fluid gain?

A

PCV and total solids

32
Q

What is more of a problem with AKI, and it happens when the kidneys are so damaged that they aren’t making enough glomerular ultrafiltrate?

A

Overhydration

33
Q

I am going to use the ins and-outs method of calculating a fluid rate. I have to answer 3 questions to calculate this.

A
  1. Is Jake breathing? If no, no fluid therapy is needed.
    If yes, give 22 ml/kg/day.
  2. How much urine is Jake making? Give that amount back. This part needs to be adjusted throughout the day, as it can change.
  3. Is Jake losing fluids from some other route?
    If yes, I should add in a little something to replace those losses. If no other losses, I can ignore this.
34
Q

angiotensin converting enzyme inhibitors

A

enalapril

35
Q

angiotensin receptor blockers

A

telmisartan

36
Q

What can anesthetic or sedative drugs do?

A

decrease renal perfusion

37
Q

AKI has 5 stages which are:

A
  • Insult,
  • Initiation
  • Extension
  • Maintenance
  • Recovery
38
Q

Hypoxia leads to _____________ , which chokes off blood supply, leading to more hypoxia

A

cellular swelling

39
Q

a condition in which the body or a region of the body is deprived of adequate oxygen supply at the tissue level

A

Hypoxia

40
Q

Means slow heart rate, is classic, but it is not always present

A

Bradycardia

41
Q

If the EKG looks like a _________ wave, act fast because that EKG will become a flat line if you fumble

A

sine

42
Q

Where does Aldosterone come from?

A

Adrenal Gland

43
Q

What causes the principal cells of the distal tubule to reabsorb sodium and secrete potassium?

A

Aldosterone

44
Q

Aldosterone decreases

A

K+

45
Q

K+ increases

A

Aldosterone

46
Q

What helps decrease serum potassium levels but take 20-30 minutes to have an effect?

A

insulin, dextrose to cause endogenous insulin release, beta-agonists, and maybe bicarbonate.

47
Q

(T/F) Calcium changes the potassium concentration

A

False

48
Q

Severe _____________ can increase the resting potential to the threshold potential, impairing the ability of the cell to repolarize

A

hyperkalemia

49
Q

Treatment with _____________ restores the gradient between the resting potential and the threshold for generating an action potential, without actually changing the potassium concentration

A

calcium

50
Q

hyperkalemia can occur
with ______________

A

oliguria or anuria

51
Q

hypokalemia can occur with ____________-

A

polyuria

52
Q

A potassium of _____ is frequently associated with changes, although the rate at which the potassium rises does impact clinical signs

A

7.5

53
Q

If the EKG was very bad, what would I use?

A

calcium gluconate

54
Q

It has a number of side effects

A

sodium bicarbonate

55
Q

The tubular damage associated with AKI can cause:

A
  • Disruption of processes that require energy and oxygen
  • Disruption of the structure (cytoskeleton) of the epithelial cells
  • Inflammation
56
Q

Treatment of AKI involves:

A
  • Maintaining appropriate fluid balance
  • Treating sequelae of AKI like vomiting, anorexia, hyperkalemia, hypertension, if present
  • Treating the specific etiology, if known and treatable
56
Q

Treatment of AKI involves:

A
  • Maintaining appropriate fluid balance
  • Treating sequelae of AKI like vomiting, anorexia, hyperkalemia, hypertension, if present
  • Treating the specific etiology, if known and treatable
57
Q

Formula to calculate maintenance fluid rates are appropriate for patients with ________

A

average urine output

58
Q

A decrease in urine volume is:

A
  • Appropriate adaptive response to decreased blood flow to the kidney
  • A sign that blood flow to the kidney has decreased and that an adequate volume of ultrafiltrate is no longer being filtered at the glomerulus
59
Q

you will use the diuretic _____________ to treat congestive heart failure

A

furosemide

60
Q

lack of urine production

A

anuric

61
Q

A patient you are treating for anuric AKI develops hyperkalemia and EKG abnormalities. How are you going to treat it?

A

Give furosemide to increase urine flow to the distal nephron

62
Q

Most animals with CKD are _____________

A

Polyuric

63
Q

Large bladder suggests __________, but is considered a “soft” finding

A

polyuria

Urinary Exam 1 (11 decks)

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