Unit 1: Chapter 34

Question 1

Acute Kidney Injury

Answer 1

Represents a rapid decline in kidney function that happens without a few hours or within a day.
Decreased blood flow to kidney
Buildup of nitrogenous waste (azotemia) products and impairs fluid and electrolyte balance.
Decrease in GFR
Reversible if can be corrected

Question 2

GFR

Answer 2

Glomerular filtration rate
With a decrease in this rate excretion of nitro go us waste is reduced and fluid and electrolytes cannot be maintained

GFR is used as a guide for stages of CKD
Beginning with kidney damage with normal or elevated GFR, progressing to CKD and potentially failure

Question 3

AKI Classifications

Answer 3

1. Prerenal
2. Intrinsic Or Intrarenal
3. Postrenal

Question 4

Prerenal AKI

Answer 4

Caused by decreased blood flow to the kidneys

Question 5

Intrarenal or Intrarenal AKI

Answer 5

Caused by disorders in the kidney itself

Question 6

Postrenal AKI

Answer 6

Caused by obstruction to urine output

Question 7

Main Cause of AKI

Answer 7

Is ischemia, sepsis or nephrotoxic agents

Question 8

Four Phases of AKI

Answer 8

1. Onset phase: (hrs/days)which is the time fromt he onset of the precipitating event until tubal injury occurs
2. Oliguria/anuric phase: (8-14 days) during which there is marked decreased int he GFR causeing sudden retention of endogenous metabolites. Urine is at its lowest.
3. Diuretic Phase: in which the kidney try to heal and urine output increased but tubule scarring and damage occur
4. Recovery phase: during which the GFR, urine output and blood levels of nitrogenous waster return to normal

Question 9

Chronic Kidney Disease

Answer 9

GFR best measure of function
Either kidney damage or a GFR less than 60 mL/min/1.73 for 3 months or longer
Most common: hypertension and DM
Progressive decline in fucntion because of permanent loss of nephrons

Question 10

CKD Guidelines

Answer 10

1. A GFR < 15mL/min/1.73 usually accompanied by most of the s&s of uremia
2. A need to start renal replacement therapy (dialysis or transplantation)

Question 11

Disorders of Calcium, Phosphorus Metabolism and Bone Disease

Answer 11

Abnormalities of these occur early in the course of CKD.
Phosphate excretion is impaired with deteriorating renal function causeing and increase thus decrease of Calcium.
Decreased calcium causes PTH release with a result of increase Ca resorption from bone.

Question 12

Vitamin D and CKD

Answer 12

Vit D synthesis is impaired with CKD.
Kidneys regulate Vit D activity by converting the inactive form to calcitriol.
Calcitriol have direct suppressive effect on PTH production
So reduced levels of calcitriol causes elevation of PTH.

Question 13

Acute Tubular Injury or Necrosis (ATN)

Answer 13

Characteriezed by the destruction of the tubular epithelial cells with acute supression of renal function
Occurs in people with extensive surgery, sever Hypovolemic or overwhelming sepsis, trauma or burns

Question 14

ATN Causes

Answer 14

Acute tubular damage because of ischemia, sepsis, nephrontoix effect of drugs, tubular obstruction and toxins form a massive infection
Tubular cells are sensitive to ischemia and vulnerable to toxins.
Damage can be reversible.

Question 15

Uremia

Answer 15

Urine in the blood
Clinical manifestation of kidney failure
Onset s&S: weakness, fatigued nausea and apathy are subtle. Extreme weakness, vomiting, lethargy and confusion
Include s&s of altered fluid, electrolytes, and acid base balance, alternations in regulatory functions.

Question 16

Anemia

Answer 16

Chronic anemia (13.0 g/dlmen, ,12g/dl women)
Is the most profound hematology alteration that accompanies CKD.
Assessment: measure of hemoglobin, hematocrit and iron studies
Due to chronic blood loss, hemolysis, bone marrow suppression and decreaed red cell production because of production of erythropoietin and iron deficiency.

Question 17

Erythropoietin

Answer 17

Kidneys are primary site for this hormones production
Controls red blood cell production

Question 18

Anemia s&S

Answer 18

Weakness
Fatigue
Hea he
Irritability
Depression
Insomnia
Decreaed cognitive function

Question 19

Hypertension

Answer 19

Common and early manifestation of CKD
Multifactorial: increased vascular volume, elevation of peripheral vascular resistance, decreased levels of renal vasodilator prostaglandins and increased activity of renin angiotensin system

Question 20

Heart Disease

Answer 20

Spectrum of CVD because CKD includes left ventricular hypertrophy and ischemic heart disease
People with CKD have increaed prevlacen of left ventricular dysfunction with both depressed left ventricular ejection fraction
CHF and PE tend to occur in late staged of kidney failure

Question 21

Pericarditis

Answer 21

Occurs with people ion stage 5 CKD due to uremia and prolonged dialysis
Manifestations: cardiac tamponade, mild to sever CP with resp accentuation and a pericardial friction rub.

Question 22

Elimination of Drugs

Answer 22

Main organ: kidneys
CKD can interfere with the absorption, distribution and elimination of drugs
Drugs bind to plasma proteins: albumin
A decreased of plasma proteins as seen in CKD means less protein bound drugs and more free drugs.

Question 23

Hydrolysis

Answer 23

Pathway of drug metabolism
Slowed with uremia

Question 24

Hemoglobinlobinuria

Answer 24

Presen of hemoglobin in urine from excessive blood cell breakdown.
Significantly impacts the kidneys, leading to potential damage like AKI or CKD through tubular obstruction, heme, toxicity, and vascoconstruction.

Question 25

ATN Recovery Phases

Answer 25

1. Initiation phase: initial stage, lasts hours to days. Onset of ischemia or toxin. Rapid decreased in GFR 2. Maintenance Phase: 1-3 weeks. Low ursine output (Oliguria), kidney Dysfuntion, high creat/BUN, lytes emblances 3. Recovery phase: 10-14 days. tubular cell repair and regeneration. Increase in urine output(diureses or poly uria. 3-5 L/day