PATHO/PHARM EXAM 4 > Chapter 28 > Flashcards

Chapter 28 Flashcards

Acute Kidney Injury & Chronic Kidney Disease (41 cards)

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1
Q

What is Acute Kidney Injury (AKI)?

A

Reduction of kidney function

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2
Q

ACUTE KIDNEY INJURY
-What are the 3 categories of AKI?

A
  1. Prerenal
  2. Postrenal
  3. Intrinsic/Intrarenal
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3
Q

ACUTE KIDNEY INJURY
-What is prerenal?

A

Diminished renal perfusion

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4
Q

ACUTE KIDNEY INJURY
-What is postrenal?

A

Obstruction of normal outflow of urine (distal to the kidney)

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5
Q

ACUTE KIDNEY INJURY
-What is intrinsic/intrarenal classified by?

A

the specific anatomic area involved –> blood vessels, tubules, glomeruli, or interstitial

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6
Q

ACUTE KIDNEY INJURY
-Distinction between the type of AKI helps determine what?

A

Appropriate therapy

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7
Q

PRERENAL KIDNEY INJURY
-Why does this develop?

A

Because of diminished perfusion of the kidney

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8
Q

PRERENAL KIDNEY INJURY
-What is a way to remember what causes prerenal kidney injury?
-What does it stand for?

A

3 Rats Fell BehindOur Entire Dresser
-Hypovolemia, hypotension, HF
-Renal artery obstruction
-Fever, vomiting, diarrhea
-Burns
-Overuse of diuretics
-Edema, ascites
-Drugs

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9
Q

PRERENAL KIDNEY INJURY
-What drugs can cause hits?

A

ACE inhibitors, angiotensin II blockers

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10
Q

POSTRENAL KIDNEY INJURY
-What is this?
-What can it lead to?

A

-Obstruction within the urinary collecting system distal to the kidney
-Buildup of waste in the kidneys

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11
Q

POSTRENAL KIDNEY INJURY
-Clinical findings of postrenal kidney injury are based on what?
-What will porlonged postrenal kidney injury progress to?

A

-The duration of the obstruction
-Intrinsic kidney injury

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12
Q

INTRINSIC/INTRARENAL KIDNEY INJURY
-What is this?

A

Dysfunction of the nephrons (glumerular, vascular, or intestinal etiologies)

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13
Q

INTRINSIC/INTRARENAL KIDNEY INJURY
-What is the most common?

A

Renal tubules resulting in acute tubular necrosis (ATN)

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14
Q

INTRINSIC/INTRARENAL KIDNEY INJURY
-What causes ATN?

A
  1. Nephrotoxic insult
  2. Ischemic insults
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15
Q

INTRINSIC/INTRARENAL KIDNEY INJURY
-What is the most common offending agent that causes nephrotoxic insults?

A

Contrast media

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16
Q

INTRINSIC/INTRARENAL KIDNEY INJURY
-What is the most common cause of ischemic insults?

A

Sepsis

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17
Q

INTRINSIC/INTRARENAL KIDNEY INJURY
-There are 2 pathophysiologic processes that result in rapid decrease in GFR. What are they?

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A
  1. Vascular
  2. Tubular
18
Q

INTRINSIC/INTRARENAL KIDNEY INJURY: Vascular
-What does this do?

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A
  1. Renal blood flow decreases by 30-50% in ATN –> blood is shunted from the medulla to the cortex, further compromising the medullary cells
  2. Vasoconstriction increases
  3. Hypoxia OR distal tubular damage trigger inflammation
19
Q

INTRINSIC/INTRARENAL KIDNEY INJURY: Tubular
-What is this?

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A

Inflammation & reprofusion injury

20
Q

INTRINSIC/INTRARENAL KIDNEY INJURY
-Describe how this ends

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A

It can repair itself OR if injury is sustained, it leads to end-stage renal disease

21
Q

ACUTE KIDNEY INJURY: Diagnosis
-What helps differentiate prerenal from instrinsic/intrarenal kidney injury?

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A

Laboratory findings

22
Q

ACUTE KIDNEY INJURY: Treatments
-How are prerenal/postrenal treated?

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A

By addressing their specific etiologies

23
Q

ACUTE KIDNEY INJURY: Treatments
-How is intrinsic kidney injury treated?

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A

with many of the same interventions used to support renal function in chronic kidney disease

24
Q

ACUTE TUBULAR NECROSIS PHASES
-What are the 3 phases?

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A
  1. Prodromal
  2. Oliguric
  3. Postoliguric
25
**ACUTE TUBULAR NECROSIS PHASES** -Describe what ATN is
A subtype (specific type) of acute kidney injury
26
**ACUTE TUBULAR NECROSIS PHASES**: *Prodromal Phase* -What is this? -What happens? -What has occurred?
-Normal or declining urine output -Serum blood nitrogen urea (BUN) & creatinine begin to rise -Insult to the kidney
27
**ACUTE TUBULAR NECROSIS PHASES**: *Prodromal Phase* -Duration of this phase will vary depending on what three things?
1. Cause of the injury 2. Amount of toxin ingested 3. Duration & severity of hypotension
28
**ACUTE TUBULAR NECROSIS PHASES** -What do most patients with AKI develop?
Oliguria
29
**ACUTE TUBULAR NECROSIS PHASES**: *Oliguric Phase* -What happens here? -What is this characterized by? -What are the signs/symptoms? -What may be required?
-Body retains water & waste products -oliguria & progressive uremia, decreased GFR, hypervolemia -fluid excess, HYPERkalemia, uremic syndrome -Dialysis
30
**ACUTE TUBULAR NECROSIS PHASES**: *Post-oliguric Phase* -Termination of the oliguric phase is marked by what? -Everyone recovers (T/F) -What happens? -What is characteristic until the kidneys recover?
-the beginning of renal recovery -FALSE; Not ALL recover -urine volume increases (diuresis), tubular function impaired, & azotemia continues -Fluid volume deficit
31
**ACUTE TUBULAR NECROSIS PHASES**: *Post-oliguric Phase* -How long may this last? -How long is full recovery?
-2 to 10 days -1 year
32
**ACUTE TUBULAR NECROSIS PHASES**: *Post-oliguric Phase* -How do you determine full recovery?
Serum creatinine & BUN levels return to normal
33
**ACUTE TUBULAR NECROSIS PHASES**: *Post-oliguric Phase* -What often persists?
A degree of renal insufficiency
34
**CHRONIC KIDNEY INJURY** -How is progression monitored? -Higher stage = ?
-By a staging system (based on increasing severity of disease) -GFR & kidney function **DECLINES**
35
**CHRONIC KIDNEY INJURY** -What is Stage 1?
-Kidney function MAY be normal even though some disease exists -Patient is asymptomatic
36
**CHRONIC KIDNEY INJURY** -What is the focus of stage 1 & stage 2?
minimizing risk factors
37
**CHRONIC KIDNEY INJURY** -What is Stage 3?
Symptoms may start to appear & treatment may be needed
38
**CHRONIC KIDNEY INJURY** -What is Stage 4?
Planning for dialysis OR transplant should begin
39
**CHRONIC KIDNEY INJURY** -What is dialysis?
Removing metabolic wastes & correcting fluid and electrolyte abnormalities
40
**CHRONIC KIDNEY INJURY** -What is Stage 5?
Renal replacement therapy needed OR death will ensue
41
**CHRONIC KIDNEY INJURY** -What is the focus of intervention UNTIL Stage 4 or 5?
Slowing the progression of CKD
PATHO/PHARM EXAM 4
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