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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