Acute Kidney Injury

Pharmaceutical Sciences Phpr 3823 with Mc Cluggage at Lipscomb University

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By: Joel Daniel
Created: 2011-10-12
Size: 32 flashcards
Views: 39

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Definition of Acute Kidney Injury (AKI)

Abrupt loss of kidney function

Retention or urea and other waste products

Dysregulation of extracellular volume and electrolytes

Lab values used in monitoring of kidney function

BUN

Urine Electrolytes (FE_NA, etc)

Urinalysis

Urine Output

GFR

Discuss the FE_Na

Tells us if the body is holding onto water

Low = dehydration

Diuretics, specifically loops, throw off our ability to interpret FE_Na

What are limitations of the Cockcroft-Gault method of estimating CrCl

Developed in healthy male patients

Not as accurate in patients with decreased renal function

Not accurate in patients with changing S_Cr

What is the Cockcroft-Gault Equation

CrCl = [(140-age)*IBW]/(72*S_Cr)

0.85 factor is female

Do we use Adjusted BW if >120%IBW for CG?

No, we are wanting lean body mass.

However, you do use Actual BW if <IBW

When is MDRD a better indicator of renal function than CG?

Patients with decreased GFR

Understimates GFR if >60ml/min

Do not use MDRD for dosing

In which of the following would CrCl likely be underestimated?

· Vegetarian

· Body Builder

· Elderly

· Cirrhosis

Body Builder

Body builders will have more muscle, so they will have a high Scr, wo we will have an underestimated CrCl

What is RIFLE, in respect to AKI?

Assessment of different degrees of injury

Risk

Injury

Failure

Loss

ESRD

What are imputs into determination of the RIFLE stage?

S_Cr

GFR decrease

UOP

What are the main differences between RIFLE and AKIN

AKIN in 3 stages

AKIN does not use GFR decrease

AKIN only accounts for changes within 48 hours

A change in S_Cr affects CrCl more at (low/high) GFR

High GFR (low S_Cr)

Remember that CrCl is inversely proportional to S_Cr

What is the effect (MOA) of prostaglandins on renal perfusion?

Vasodilation of the AFFERENT arteriole

Lets in more blood flow to the glomerulus

What is the effect (MOA) of NSAIDS on renal perfusion?

Blocking the production of prostaglandins

Blocking the vasodilation of the AFFERENT arteriole

Reducing the blood flow to the glomerulus

What is the effect (MOA) of Angiotensin II on renal perfusion?

Vasoconstriction of the EFFERENT arteriole

Increase glomerular gradient pressure (increased UOP)

What effect would an ACE-I, ARB, or direct Renin Inhibitor have on renal profusion?

Blocking the production of Angiotensin II

Blocking the Vasoconstriction of the EFFERENT arteriole

Decrease glomerular gradient pressure (decreased UOP)

Lab Values for Pre-Renal AKI

BUN/S_Cr > 20:1

FE_Na <1%

Na_urine <20

Osm_Urine >500 Osm
Urine Casts: Hyaline casts or none

Physical Exam finding for Pre-Renal AKI

Dehydration (Poor skin turgor, Dry mucus membranes)

Orthostatic Hypotension

Low BP

Tachycardia

Tx of Pre-Renal AKI

DC NSAIDS/ACE-I/ARB (switch)

Hold BP medication

Hold Diuretics

Fluids

Monitoring for patients with Pre-Renal AKI

UOP

Electrolytes [K (biggest concern), Na, Ca, Mg]

S_Cr

BUN

Weight

Types of Intrinsic AKI

Acute Tubular Necrosis (ATN) either ischemic or nephrotoxic

Acute Interstitial nephritis (AIN)

Glomerulonephritis

Lab Values associated with Intrinsic AKI

BUN/Scr <20:1

FENA >2%

Na_urine >40

Osm_urine <350 (low)

Muddy brown casts (microscopic)

Non-modifiable Risk factors for CIN

Older age (.75)

Pre-existing Renal failure (GFR <60)

CHF

Renal transplant

Acute MI

Modifiable Risk Factors for CIN

Volume/Type of Contrast

HYPOtension

Anemia

Dehydration

Low Serum Albumin

ACE-I (hold 5 t_1/2 before if possible)

NSAID (hold 5 t_1/2 before if possible)

Nephrotoxic Abx

CIN Prevention

DC metformin (to prevent lactic acidosis, 48h before/after)

DC other nephrotoxic medications if possible

Choice of contrast dye

Volume load (NaHCO₃ or NS, day before/day after)

Consider NAC (≥2 Risk Factors, battle oxidative stress)

S/Sx and Labs for AIN

S/Sx

Fever, rash, arthralgia

Labs

Eosinophiluria

Eosinophilia

Leukocyte casts

Management of AIN

DC offending agent (list as allergy!!!)

Supportive Care (may need TEMPORARY dialysis)

PO Steroids if no change after DC offending agent

S/Sx and Labs for Glomerulonephritis (GN)

S/Sx

HTN, Edema

Labs

Hematuria

Proteinuria

RBC casts in urine

Acute GN Tx

Edemia

Na restriction

Loop Diuretics

HTN

ACE-I, ARB, or nondihydropyridine CCB

Proteinuria

Low protein diet (Short Term)

ACE-I and/or ARB (caution – avoid pre-renal)

Lab Values for Post-Renal AKI

FE_Na >1%

Urate cyrstals

Phosphate cyrstals

Decreased UOP

Distended Bladder or enlarged prostate

Tx for Post-Renal AKI

Relieve Obstruction

DC contributory medications

Consider catherization

Indications for Acute Dialysis

A: Acidosis

E: Electrolyte Disturbance

I: Intoxication

O: Overload

U: Uremic (high BUN)

About this deck

By: Joel Daniel
Created: 2011-10-12
Size: 32 flashcards
Views: 39

About StudyBlue

“I have used this website for three exams, and I see a huge difference in my test results.”
Naj