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21 Cards in this Set
- Front
- Back
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what is the definition of Acute Kidney Injury |
A decline in renal excretory function over hours or days that can result in failure to maintain fluid, electrolyte and acid-base homeostasis |
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What are the symptoms of AKI? |
- nausea, vomiting - dehydration - decreased urine output - drowsiness - confusion - shortness of breath - fatigue - high blood pressure - chest or abdominal pain - swelling in legs, ankles or feet |
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Outline the risk factors of AKI |
- age >65 - being hospitalized, especially for a serious condition that requires intensive care - blockage in the blood vessels in your arms or legs - chronic conditions such as HF, diabetes, liver disease - symptoms or history of urological obstruction or conditions that may lead to obstruction - history of AKI - chronic kidney disease - sepsis - oliguria - hypovolaemia - nephrotoxic drug use within the past week (NSAIDs, ACE inhibitors, ARBs and Diuretics) - Neurological or cognitive impairment or disability, which may mean limited access to fluids because of reliance on a carer - Use of iodinated contrast agents within the past week |
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what is sepsis? |
細菌感染症にかかったあと、体内の一部にその菌による病巣ができ、その病巣から血液中にたえまなく菌が出ている病態のこと。 |
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what is hypovolemia? |
血液量減少症) |
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For causes of AKI, what are the three categories? |
Pre-renal: a sudden, serious drop in blood flow to the kidneys Renal: damage from some medicines, poisons, or infections Post-renal: a sudden blockage that stops urine from flowing out of the kidneys |
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Explain the cause; Pre-renal |
Pre-renal cause (Functional) - hypovolemia (such as bleeding, low BP, GI losses, burns) - Sepsis - Heart conditions (cardiac arrhythmias, myocardial infarction, heart failure) - Renal artery stenosis - Pancreatitis and liver disease |
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Explain the cause; Renal |
Renal cause (damage) - prolonged hypoperfusion causing tubular injury (ischaemia, myeloma, hemolysis and ahabdomyolysis) - Glomerular (Glomerulonephritis and postinfectious) - Interstitial (interstitial nephritis) - Vascular (vasculitis, thrombosis, athero/thromboembolism, renalartery stenosis, cholesterol emboli, malignant hypertension) - Drugs such as NSAIDs and ACE inhibitors |
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Explain the cause; post-renal |
Post-renal (functional) - pelvic masses (such as cervical cancer) - Retropertoneal fibrosis - Renal stone disease - Pyonephrosis - Papillary necrosis - Prostatic hypertrophy/cancer - Bladder tumor - Urethral stricture |
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what are the possible complications of AKI? |
- Hyperkalaemia - Volume overload - hyperphosphataemia - Metabolic acodosis - Uraemia - Chronic progressive kidney disease - Endo-stage renal disease |
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what are the two methods of treatments associated with AKI? |
You can either; treat the underlying cause or/and treat the complication |
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what do you mean by the treating the underlying cause? |
• Pre renal and secondary to known conditions suchas haemorrhagic, septic shock, a diarrhoeal illness
• Urinary catheter to relief of lower urinary tractobstruction, or to monitor hourly urine output • Adequate oxygenation and haemoglobinconcentration |
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what do you mean by the treating complications? |
• Treatments to correct the amount of fluidand electrolyte balance
• Medications to control blood potassiumand to restore blood calcium levels • Dialysis to remove toxins from blood |
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what are the community setting of treatment of AKI? |
• Advise stopping any medication that may be the cause
• Treat any underlying infections • Advise on fluid intake to prevent dehydration (which couldcause or worsen AKI) • Take blood tests to monitor levels of creatinine and salt, tocheck their patient is recovering • Refer their patient to a urologist (urinary specialist) ornephrologist (kidney specialist) if the cause isn't clear orif a more serious cause is suspected |
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what are the hospital settings of treatment of AKI? |
• The underlying cause – such as a urinary blockage
• A risk of urinary blockage – such as prostate disease • The patient's condition has deteriorated - regular bloodand urine tests to monitor renal function • A complication of AKI |
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what is the general management of AKI? |
-Appropriate fluid therapy, -administration ofvasopressors and/or inotropes -treatment of any underlying sepsis. -Nephrotoxic medications should be stopped |
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what is the nutritional support to manage AKI? |
− 25-35 kcal/kg/day and up to a maximum of 1.7gamino acids/kg/day if hypercatabolic and receivingcontinuous renal replacement therapy.− Trace elements and water soluble vitamins shouldbe supplemented as required.
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what are the risk of kidney transplantation? |
- infection - risk of failure - malignancy - diabetes - CVD - side effects of the drugs necessary for transplant |
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what is malignancy? |
tending to become worse and end in death. |
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what are the drugs necessary for transplant? |
They are immunosuppressants - induction drugs (powerful anti-rejection medicine used at the time) - maintenance drugs (low dose anti-rejection medications used for the rest of their life, or until the new kidney fails) |
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what are the types of drugs used for induction immunosuppressants |
a combination of 3 medicines; • Calcineurin inhibitors e.g. Ciclosporin or Tacrolimus • Antiproliferative agents e.g. Azathioprine • Corticosteroids e.g. prednisolone |
