56 terms

AKI okogbaa

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CKD rather than AKI
seeing 2 small kidneys means?
AKI
while u have CKD, if u see the Scr shoot up, what does that mean?
something block urinary tract

shock, necrosis (catastrophic event)
Acute anuria is caused by _____ or _____
prerenal azotemia
oliguria suggests...
acute intrinsic renal failure

incomplete urinary obstruction
nonoliguric renal failure comes from?
nonoliguric AKI
when a patient has AKI and still has a normal urine output, this is?
age, gender, muscle mass, diet, hydration status
Scr is dependent on?
AKI patients with unstable renal function
when should we not use Cockcroft Gault, MDRD, and CKD EPI equations?
urea's production and renal clearance are influenced by extrarenal factors (critical illness, volume status, protein intake, and medications)
Why is BUN limited in determining AKI?
complete blood cell count
What can help rule out infectious causes of AKI?
< 15:1
in people with normal renal function, ratio between BUN and Scr is?
20:1+
in people with pre-renal AKI, what ratio is often seen between BUN and Scr?
prerenal azotemia
when we find a high urinary specific gravity, without glucosuria or mannitol affecting it, what does this mean?
other causes of + urine protein , such as the presence of blood or tubular damage
when + urine protein is assessed, what confounding factor must be assessed first?
glomerular injury

infection

kidney stone
hematuria (blood in urine) suggests acute intrinsic AKI secondary to?
nephrolithiasis and postrenal obstruction
finding urinary crystals may indicate?
physical injury to :

glomerulus

renal parenchyma or

vascular beds
if u find red blood cells or casts, this indicates?
interstitial inflammation that can be secondary to an allergic, granulomatous, or infectious process.
if you find white blood cells or casts, this suggests?
pre-renal azotemia
a low urinary sodium concentration and FEna in a patient with oliguria suggests?
FEna (>2%), tubular damage
the inability to concentrate urine results in a high _____, suggesting ______
ADH

tubular function
highly concentrated urine suggests?
ultrasonography
What imaging technique can be used to reveal small, shrunken kidneys indicative of CKD?
renal ultrasonogram/ or CT scan
postrenal obstruction can be identified with?
ultrasonography

KUB, CT (more sensitive)
How do we determine neprholithiasis as small as 5 nm or a narrowing of ureteral track?
isotonic saline
What drugs are indicated for the prevention of both AKI and CI-AKI?
False, just CI-AKI
isotonic saline is recommended for treatment of both AKI and CIAKI
False just CI-AKI
NAC is recommended for prevention of both AKI and CIAKI
hemorrhagic shock
Isotonic saline is recommended for AKI in the absence of?
isotonic saline
NAC is recommended for CI-AKI in combination with?
Vasopressors
what drug is recommended only for AKI?
fluids
Vasopressors are recommended for vasomotor shock in combination with?
slower rehydration- 250 ml bolus or 100 ml/h infusions of saline or crystalloid solution to reduce risk of edema
how do we hydrate patients w/ anuria or oliguria?
electrolyte imbalance susceptible to large and rapid infusions
isotonic saline has been associated with hyperchloremic metabolic acidosis and acid-base imbalance if dehydration is accompanied by?
IV rehydration of 5% Dextrose, 0.45% NaCl, + 50 mEq of sodium bicarb/ L (give as bolus then infuse)
dehydration due to diarrhea accompanied with metabolic acidosis caused by bicarbonate losses should be treated how?
intermittent hemodialysis
what is the most frequently used RRT?
quick removal of volume and solute and correction of most of the electrolyte abnormalities
Advantages of IHD?
hypotension due to rapid removal of volume
challenges to IHD?
only given parenterally

little nonrenal clearance

can cause AKI
disadvantages of mannitol given to anuric or oliguric patients?
oral bioavailability

ototoxicity--> high dose bolus infusions
disadvantage of furosemide?
predictable oral bioavailability

more potent
how are torsemide and bumetanide better than furosemide?
torsemide
which loop has the longest duration of action?
patients with sulfa allergies
when is ethacrynic acid used?
those that work at the DCT and collecting duct (Thiazide and K sparing)
what diuretics produce synergism when administered with loop diuretics?
metolazone- effective diuresis at GFR< 20.
which diuretic works best as a combo with loop?
aminoglycoside

contrast media

amphotericin B
what drugs cause acute tubular necrosis?
ACEI

ARB

NSAIDS
what drugs cause hemodynamically mediated kidney injury?
acyclovir

methotrexate
what drugs cause obstructive nephropathy (intratubular)?
sulfonamides

triamterine
what drugs cause obstructive nephropathy (kidney stones)?
Gold

lithium
what elements can cause glomerular disease?
penicillins

NSAIDS

PPI
what drugs can cause acute allergic interstitial nephritis?
warfarin

thrombolytic agents
what drugs can cause cholesterol emboli?
<30
at what glomerular filtration rate do we stop using exenatide?
<50
at what glomerular filtration rate do we stop using glyburide?
<30
at what glomerular filtration rate do we stop using HCTZ?
<10
at what glomerular filtration rate do we stop using metformin?
<10
at what glomerular filtration rate do we stop using spironolactone?