Therapeutics: AKI 1

Card Set Information

Author:
kyleannkelsey
ID:
272590
Filename:
Therapeutics: AKI 1
Updated:
2014-05-02 18:36:43
Tags:
Therapeutics AKI
Folders:
Therapeutics: AKI
Description:
Therapeutics: AKI
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user kyleannkelsey on FreezingBlue Flashcards. What would you like to do?


  1. What are the signs of Prerenal AKI?
    • Urine sediment: Hyline casts may be normal
    • Urinary RBC: None
    • Urinary WBC: None
    • Urine Na: <20
    • FE(Na) %: <1
    • Urine serum osmolality: >1+
    • Urine Cr/Serum Cr: >40:1
    • BUN/SCr: >20
    • Urine specific gravity: >1.018
  2. What are the signs of Intrinsic AKI?
    • Urine sediment: Granular casts cellular debris
    • Urinary RBC: 2-4+
    • Urinary WBC: 2-4+
    • Urine Na: >40
    • FE(Na) %: >2
    • Urine serum osmolality: <1.3
    • Urine Cr/Serum Cr: <20:1
    • BUN/SCr: ~15
    • Urine specific gravity: <1.012
  3. What are the signs of Postrenal AKI?
    • Urine sediment: Cellular debris
    • Urinary RBC: Variable
    • Urinary WBC: 1+
    • Urine Na: >40
    • FE(Na) %: Variable
    • Urine serum osmolality: <1.5
    • Urine Cr/Serum Cr: <20:1
    • BUN/SCr: ~15
    • Urine specific gravity: Variable
  4. An FE(Na) of <1% indicates what?
    • Prerenal/functional AKI
    • Tubular function intact
    • Can reabsorb Na and Concentrate
  5. An Fe(Na) of >1% indicates what?
    • Acute Intrinsic AKI
    • Tubular damage
    • CANNOT reabsorb Na and Concentrate
  6. What is a normal urine osmolality?
    >500
  7. What urine osmolality indicates that the patient cannot concentrate urine?
    <350
  8. What BUN/Cr ratio indicates pre-renal injury?
    >20
  9. What BUN/Cr indicates non-pre-renal injury?
    <20
  10. What drugs are not useful in AKI?
    • Loop diuretics
    • Low dose dopamine (arrhythmias)
    • Atrial natriuretic peptide
    • Fenoldopam (DA agonist)
    • Recombinant human insulin-like growth factor
    • N-acetylcysteine
  11. What drugs have a definite/possible benefit in prevention of AKI?
    • Normal saline infusion
    • Sodium bicarbonate infusion
    • Ascorbic acid
  12. How would you administer Saline to prevent AKI?
    • Normal saline IV
    • 1 mL/kg/h
    • 3-12h before and 6-24h after procedure
  13. How would you administer a Sodium bicarbonate infusion to prevent AKI?
    • NaHCO3 IV drip
    • 154 mEq/L infused at 3 mL/kg/h
    • 1h before and 1 mL/kg/h for 6h after procedure
  14. How would you administer Ascorbic acid to prevent AKI?
    • 3g PO before
    • 2g po BID x2 after the procedure
  15. What are the indications for renal replacement therapy?
    • A= Acid-base abnormalities
    • E= Electrolyte imbalance
    • I= Intoxications
    • O= Fluid Overload
    • U= Uremia
  16. By what modes can substances be removed from blod using dialysis?
    • Diffusion
    • Convection
    • Adsoprtion
  17. Which removes more drugs, IHD or PD?
    IHD
  18. A patient on dialysis will require anticoagulation to avoid coagulation on the dialysis membrane, tubing or catheter, what is an appropriate anticoagulant?
    • Regional anticoagulation
    • Intermittent RRT: UFH or LMWH (sometimes saline)
    • CRRT: Regional citrate anticoagulant
  19. What is the MOA of Regional citrate anticoagulant?
    Chelates Calcium
  20. What diuretics can you use in a non-oliguric fluid overloaded Aki patient?
    • First try: Furosemide 40-80 mg and assess status after that
    • Can also use: Butenamide, Torsemide and ethacrynic acid
    • Can give Loop + Thiazide to avoid diuretic resistance (Chlorthizide or Metolazone 5 mg 30 min before loop)
  21. What is Anuric?
    UOP of <50 mL/day
  22. What is Oliguric?
    UOP of 50-500 mL/day
  23. What is Nonoliguric?
    UOP > 500 mL/day
  24. What are the general definitions of AKI?
    • Elevation of SCr > or = to 0.5 mg/dL above normal
    • Elevation of SCr > or = to 1 mg/dL above normal for CKD patients
    • UOP <0.5 mL/kg/h
  25. What are AKIN definistions of AKI?
    • Increase in SCr > 0.3 mg/dL
    • Increase in SCr > 1.5 times baseline
    • UOP < 0.5 mL/kg/h for 6 hours
  26. What are AKIN stages of AKI?
    • Stage 1: >/= 0.3 mg/dL increase or 1.5-2x baseline, UOP <0.5 mL/kg/hr 6 or more hours
    • Stage 2: 2-3x increase from baseline, UOP <0.5 for 12 hrs
    • Stage 3: >3x increase from baseline, SCr >/= 4, HD or acute increase of >/= 0.5 mg/dL, UOP <0.3 for 24 hours or anuria for 12
  27. Prerenal azotomia general cause:
    • Volume depletion
    • Functional = hemodynamic changes in the glomeruli
    • Hypoperfusion of renal parenchyma
  28. Intrinsic AKI general cause:
    Structural damage
  29. Post renal AKI general cause:
    Obstruction to urine outflow
  30. What are the causes of Prerenal AKI with Hypotension?
    • Intravascular depletion
    • Dehydration, Hemorrhage, CHR and HYPOtension
  31. What are the causes of Prerenal AKI without Hypotension?
    • Renal arterial stenosis
    • Kidney emboli
  32. What generally causes functional AKI?
    • Decrease in glomerular hydrostatic pressure W/O damage to the kidney
    • Due to changes in afferent and efferent arteriolar circumference
  33. What drugs cause an increase in afferent resitance, and thus Functional AKI?
    NSAIDs, CSA
  34. What drugs cause a decrease in efferent arteriole resistance and thus Functional AKI?
    ACEIs and ARBs
  35. What is the most common cause of intrinsic AKI?
    Necrosis due to either tubular toxins or extended prerenal state
  36. What drugs can cause tubule toxicity (and thus Intrinsic AKI)?
    • Contrast Dye
    • AGs (-micin)
    • Amotericin B
    • Myoglobin
  37. What drugs can cause Postrenal AKI by renal pelvis or tubule obstruction?
    • Acyclovir
    • Methotrexate
    • Sulfonamide
    • HCTZ (increase Ca)
  38. What are normal symptoms of AKI?
    • Change in urinary habits
    • Weight gain
    • Flank pain
  39. What lab tests would you order for AKI determination?
    Urine, blood chemistries, CBC w/ differential, microscopic analysis of urine
  40. What are the signs of AKI?
    • Edema
    • Urine discoloration
    • Hypotension
    • Petechiae
    • S3 Heart sounds
    • Ascites
    • Rales

What would you like to do?

Home > Flashcards > Print Preview