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Exam 3- Acute Kidney Injury & Chronic Kidney Disease

Terms in this set (10)

Acute Kidney Injury
- the SUDDEN reduction of kidney function causing disruptions in fluid, electrolyte & acid-base balances, retention of nitrogenous waste products, increased serum creatine levels & decreased GFR (accumulation of waste in blood)
- 5 point classification system known as RIFLE
- formerly known as acute renal failure (ARF)
- represents a broad spectrum of kidney diseases ranging from minor changes in renal function to complete renal failure requiring renal replacement therapy.
3 sites of disruption in AKI
- Renal perfusion (prerenal)
- Urine flow distal to kidney (postrenal)
- Circumstances within kidney blood vessels, tubules, glomeruli or interstitium (intrinsic)
* distinction of lpcation helps determine therapy
RIFLE
R: risk
I: injury
F: failure
L: loss of function
E: end-stage kidney failure
* 1st 3 stages indicate severity of kidney injury
* Last 2 stages indicate patient outcome
Diagnosing AKI
- results in characteristic alterations in lab tests of blood & urine
- renal function monitored by serum creatine & calculated GFR
- Retention of metabolic wastes (azotemia/uremia)
Prerenal Kidney Injury
- AKI developed due to diminished perfusion to kidney ( injury occurs before kidney)
- likely caused by decrease in circulating volume or abnormal renal hemodynamics
- caused by HYPOVOLEMIA, HYPOTENSION, heart failure, renal artery obstruction / stenosis, fever, vomiting, diarrhea, burns, overuse of diuretics, edema, ascites, drugs like ace inhibitors, angiotensin blockers, & N-SAIDS
- kidney may not receive enough volume because of cardiogenic shock, heart failure, or lethal ventricular dysrhythmias
- Characterized by low GFR, oliguria, high urine specific gravity, osmolality and low urine sodium
- PROLONGED prerenal AKI can lead to intrinsic acute tubular necrosis which is a precursor to the development of chronic renal failure
- can result in hypoxia of renal cells
- fixing perfusion issue should restore normal renal function
Intrinsic / Intrarenal Kidney Injury
- primary dysfunction of nephrons & paranchyema
- Most common problem within renal tubules resulting in acute tubular necrosis (50% of all AKI results in ATN)
- May also occur w/ glomerular, vascular or interstitial etiologies like nephrotoxic insults (like contrast media) or ischemic results ( from sepsis)
- 2 pathological processes occur: 1) vascular, decrease in renal blood flow 2) tubular response: reperfusion injury ( causes casts, inflammation, backleak, obstruction of urine flow)
Postrenal Kidney Injury
- Obstruction of the normal outflow of urine from the kidneys can result in postrenal kidney injury
- can include obstruction of renal
Transfusion Reactions causing AKI
- causes hemolysis of RBCs
- reabsorption is limited leaving excess hemoglobin to build up which blocks nephrons
- RBC hemolysis causes release of vasconstrictive substances which promotes poor blood supply to tubules causing further damage
Chronic Renal Failure
- irreversible loss of nephron function
- progressive loss ( slow decline in GFR, start w/ about 60mls)
- begins as chronic kidney disease, turns to chronic renal failure, ends with end-stage renal disease
- diagnosed by decreased kidney function or kidney damage for 3 months duration based on blood tests, urinalysis , imaging studies
- caused by other health problems like hypertension and diabetes
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