Term
| What are some examples of pre-renal causes of acute kidney injury? |
|
Definition
-dec in renal blood flow or perfusion
-excessive vasoconcentriction |
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Term
| What are some examples of renal causes of AKI? |
|
Definition
-prolonged pre-renal events
-infectious dz: like lepto
-toxins
-systemic dz w/ nephrotoxic potential |
|
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Term
| What is the most common intoxicant causing AKI? |
|
Definition
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Term
| What are some examples of post-renal causes of AKI? |
|
Definition
-urethral obstruction
-bilateral uretral obstruction
-unilateral ureteral obstruction with a non-functional contralateral kidney
-urine lakage |
|
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Term
| What are the stages of kindey injury? |
|
Definition
-Initiation: period of renal injury
-Extansion: cellular injury progresses to cell death
-Maintenance: azotemia/uremia, may last for days to weeks
-recovery: may take weeks to months |
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Term
| Generally describe the cellular mechanisms of kidney injury. |
|
Definition
-when O2 depletion occurs, ATP is converted to AMP causing E deficiency
-prolonged ischemia causes death of mitochondria & loss of ability to pdc ATP
-lack of ATP reduces activity of NA/K pump
-results in cell welling, tubule obstruction, and vascular congestion
-cytoskeleton injury results from E depletion
-damage to tight junctions resutls in back-leakage of filtrate |
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Term
|
Definition
-lethargy/listlessness
-anorexia
-vomiting
-diarrea
-PU/PD
-may include seizure, syncope, ataxia, dyspnea
-dehydration
-uremic breath
-oral ulceraiton
-tongue tip necrosis
-enlarged, painful kidneys |
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Term
| What do we see on UA w/ AKI? |
|
Definition
-USG: 1.007-1.015 (isothenuric)
-glucosuria w/ normal glycemia (PCT damage)
-proteinuria/hematuria
-acidic urine
-granular casts
-Ca oxalate crystals w/ ethylene glycol |
|
|
Term
| What do we see on CBC w/ AKI? |
|
Definition
-HCT in w/ dehydration
-HCT dec w/ GI hemorrhage
-platelet count normal or low |
|
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Term
| What do we see on chem w/ AKI? |
|
Definition
-inc BUN
-in cCr
-Inc BUN/Cr ratio w/ GI bleeds
-inc Phos
-inc K
-high anion gap |
|
|
Term
| What do we see on rads w/ AKI? |
|
Definition
-normal to enlarged kidneys
-nephroliths, ureteroliths, cystoliths, or urethroliths |
|
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Term
| What do we see on U/S w/ AKI? |
|
Definition
-normal or enlarged kidneys
-renal pelvis & ureteral dilation
-lymphoma
-Ethylene glycol |
|
|
Term
| What are our general thoughts w/ Lepto testing w/ AKI? |
|
Definition
-Titers: may be neg for first 10d but look for fourfold rise after 2-4w
-PCR on urine: before abx |
|
|
Term
| Why do we perform FNA w/ AKI? |
|
Definition
|
|
Term
| What is our major concern w/ renal biopsy for AKI dx? |
|
Definition
| -inc risk of bleeding from thrombocytopathy |
|
|
Term
| What are our goals of AKI tx? |
|
Definition
-fluid therapy
-diuretics
-acid-base & electrolyte balance
-symptomatic therapy
-tx underlying problem |
|
|
Term
| Which fluids do we give to AKI patients? |
|
Definition
| -balanced fluids such as LRS, NOrmosol, or plasmalyte |
|
|
Term
| Why is placement of a closed urinary collection system vital in AKI patients? |
|
Definition
| -urine output should be measured at least every 6h |
|
|
Term
| How do we fix the hyperkalemia w/ AKI? |
|
Definition
-Dextrose to induce endogenous insulin
-sodium bicarb
-calcium gluconate 10%
-ONLY DIALYSIS WILL REMOVE k IF NO RENAL FUNCTION |
|
|
Term
| Why are AKI patients metabolically acidotic? |
|
Definition
| -kidneys cannot excrete H+ & cannot resorb bicarb |
|
|
Term
| How do we fix metabolic acidosis w/ AKI? |
|
Definition
|
|
Term
|
Definition
-Penicillin G or ampoicilin
-doxy: clears carrier state too |
|
|
Term
| How do we treat ethylene glycol? |
|
Definition
-4-methylpyrazola
-grain alcohol |
|
|
Term
| What are the three types of dialysis? |
|
Definition
-peritoneal dialysis
-contiuous renal replacement therapy
-intermittent dialysis |
|
|
Term
| What is the prognosis of canine AKI? Feline? |
|
Definition
-dogs: mortality rate of 60%
-cats: mortality rate of 40-50%
-polyuric patients have better overall prognosis |
|
|
Term
| What risk factor for AKI is exacerbated by hyponatremia? |
|
Definition
| -inc risk of damage from contrast media |
|
|
Term
| What risk factor for AKI is exacerbated by hypokalemia? |
|
Definition
| -gentamicin nephrotoxicity |
|
|
Term
| What are some potentially nephrotoxic drugs? |
|
Definition
-concurrent use of furosemide & gentamicin
-NSAIDs
-cisplatin chemo
-amphotericin B antifungal |
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