AKI-exam 2

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Ambestul
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13361
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AKI-exam 2
Updated:
2010-04-06 19:52:26
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renal
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exam 2
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  1. Definition of AKI
    occurs within 48 hrs as evidenced by: an absolute inc in serum creatinine conc of >=0.3 mg/dL above baseline, or a >=50% increase in serum creatinine conc over baseline, or documented oliguria of <0.5 ml/kg/hr for more than 6 hours
  2. azotemia
    elevation of blood urea nitrogen (BUN) and creatinine
  3. Uremia
    clinical syndrome resulting from azotemia characterized by anorexia, nausea, vomiting, & mental status changes
  4. Pre-renal causes of AKI
    dec IV vol, dec EABV, hemodynamic
  5. instrinsic causes of AKI
    Tubules(ATN)-ischemic or toxic, Interstitial-allergic or infection, Glomeruli-glomerular inflammation, Vascular-inflammation, occlusion
  6. post renal causes of AKI
    obstruction to ureters, bladder, urethra
  7. Acute tubular necrosis leads ( ) continuated by pre-renal
    ischemic (prolonged hypotension, vasoconstriction)
  8. toxic causes of AKI
    contrast dye, heavy metal poisoning, drugs causing tubular toxicity (Amph B, AGs, Contrast dye, etc), drugs causing crystal nephropathy (acyclovir, sulfonamides), intratubular pigments (myoglobin secondary to rhabdomyolysis, hemoglobin secondary to hemolysis)
  9. causes of AKI causing acute interstitial nephritis
    Abx, antivirals, NSAIDs, diuretics, allopurinol
  10. causes of AKI causing glomerular inflammation (glomerulonephritis)
    SLE, poststreptococcal glomerulonephritis, medications: NSAIDs, ampicillin, lithium
  11. causes of small vessel disease
    polyarteritis nodosa, hemolytic uremic syndrome, malignant hypertension, scleroderma
  12. causes of large vessel disease
    cholesterol emboli, thrombosis, endocarditis, renal artery stenosis, medications: oral concentrations, warfarin, thrombolytics
  13. causes of post-renal obstruction
    bladder outlet (BPH), ureteral (cancer, nephrolithiasis, crystal deposition, tumor-lysis syndrome, blood clot)
  14. non-oliguric UOP
    >500 ml/day
  15. oliguric UOP
    50-500ml/day
  16. anuric UOP
    <50 ml/day
  17. assess history for AKI
    assess for disorders predisposing pt to vol depl, renal disease & obstruction, medication history history, change in voiding habits, wt gain, nephrotoxin exposure
  18. physical assessment
    blood pressure, ECF volume status (tachycardia, orthostatic BP changes, dry mucus membranes, hypotension), physical exam, I & O's
  19. lab evaluation
    urinalysis-examine for sediment, RBC, RBC casts, proteinuria, WBC, WBC casts, eosinophils, crystals
  20. BUN:creatinine ratio (-10-20:1)
    • pre-renal >20:1
    • instrinsic (ATN) <20:1
    • post renal <20:1
  21. urine sodium
    • pre-renal <20 mEq/L
    • instrinsic (ATN) >40 mEq/L
    • Post renal >40 mEq/L
  22. FENA%
    • [urine Na * Serum Cr/Serum Na * Urine Cr]x 100
    • pre-renal <!%
    • instrinsic (ATN)>2%
    • post-renal variable
  23. factors affecting reliability of FENA
    diuretics, osmotic diuresis, CRF
  24. prevention of AKI
    identify pts at risk, correct risk factors prior to therapy-esp hydration, avoid the use of potentially nephrotoxic agents in pts at risk if possible, avoid nephrotoxic combinations, adjust the dose for renal fxn prior to therapy
  25. monitoring diuretic therapy, goal urine output
    >=ml/kg/hr, wt loss can exceed 1-2 lbs
  26. dopamine
    0.5-2 mcg/kg/min, selectively dilates renal vasculature to incr RBF and inc UOP, increases UOP but doesn't improve creatinine clearance and no evidence that it decreases mortality, monitor UOP, BP, IV site
  27. Indications for dialysis (AEIOU)
    • Acid-base abnormalities (acidosis pH<7.1)
    • Electrolyte imbalance (hyperkalemia >6.5 mEq/L; increased Mg >2.3)
    • Intoxications (Salicylates, Lithium, Methanol, Ethylene glycol, theophyllin, Pb)
    • Fluid Overload (pulmonary edema)-that have not responded to interventions
    • Uremia-(BUN>80-100 mg/dL, CNS complications, pericarditis, intractable N&V
  28. mortality causes of AKI
    infection #1 cause, CV compromise, respiratory failure, GI bleed

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