AKI & Chronic Kidney Disease

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Kidney Effect On Vitamin D?

Kidneys activate vitamin D

Vitamin D does what?

Once activated it allows Ca+ to be absorbed from the gut

Acute Renal Failure is the same as?

Acute Kidney Injury

Normal BUN

7-20mg/dl

Normal Creatinine

.8-1.4mg/dl

Normal GFR

125ml/min

Total Kidney Filtrate in 24hours?

180 Liters

Clinical Syndrome of AKI/ARF

SUDDEN decrease in GFR
Inability to maintain electrolyte balance, acid-base

Normal Out Equals Normal Kidney Function?

Not necessarily. Normal output can mean kidneys are still failing

RIFLE

Risk
Injury
Failure
Loss
End Stage

Creatinine multiplier for risk of AKI
Creatinine multiplier for Injury from AKI
Creatinine multiplier for Failure from AKI

1.5x normal / UO ≤5mL per kilo per hour x6hours
2x normal / UO ≤5mL per kilo per hour x12hours
3x normal / UO ≤.3mL per kilo per hour x24hours

PreRenal Failure Caused By?

Hypovolemia
∨ CO
∨ SVR (Anti-Hypertensives or Shock)

Intra-Renal Failure Caused By?

Hypertension
SLE (Lupus)
Interstitial Nephritis
Acute Glomerulonephritis

Interstitial Nephritis can be caused by?

NSAIDS (Severe Vasoconstriction)

Word for a accumulation of nitrogenous waste in blood.

Azotemia

Cause of PostRenal AKI?

Obstructed outflow

Kidney Dilation as a result of uretal obstruction?

HydroNephrosis

RIFLE

Risk, Injury, Failure, Loss, End Stage Kidney Disease

Most common initial manifestation of AKI?

Oliguria Phase

Oliguria Urine Output Level

<400Ml per day

Urine Osmolality with Oliguria AKI

300 (Same as Plasma Because it is Not Filtering Anymore)

Accumulation of H+ ions from lack of Ammonia Synthesis cause?

Metabolic Acidosis (<18 HCO)

Sodium ∧∨ During Oligeric Phase?

Body becomes HYPONatremic because the kidney cannot conserve sodium. (Possible Cerebral Edema)

Potassium Level During AKI?

Hyperkalemia + Even More HyperKalemia due to excess H+ ions kicking K+ out of cells.

Evidence of NeuroLogic Problem d/t Ammonia metabolism

Asterixis. Flapping tremor usually seen with Liver Disease

Diuretic Phase Cause?

Osmotic Diuresis d/t high UREA osmolality

Urine output level during Diuretic Phase?

1-3 Liters, can be 3-5Liters

Diuretic phase the urine does not?

Concentrate

Insensible Losses Should be how many mL per day?

600mL

Renal Replacement Tx Indication?

Volume Overload ; Hyperkalemia ; HCO ≤15 ; Cardiac Issues

Possible tx to prevent contrast associated Nephropathy?

Mucomyst

ACE Inhibitors can cause?

Hyperkalemia and decrease perfusion pressure.

How often should patient be weighed?

Daily

GFR for Stage 1 Kidney disease

≥90mL

GFR for Stage 2 Kidney disease Mild GFR ∨

60-90mL

GFR Stage 3 Kidney Disease Moderate Damage

30-60mL

GFR Stage 4 Kidney Disease Sever Damage

15-30mL

GFR Stage 5 Severe BAD

0-15mL

Word for when symptoms develop in multiple systems

Uremia

Triglycerides ∧∨ with Uremia?

High because of Hyperinsulism

Piss Breath

Uremic Fetor

Hyperphosphate Treament

PhosLo, Binds phoshate in bowel

Hemoglobin Levels For Kidney Failure

∨ d/t lack of erythpoetin

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