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23 Cards in this Set
- Front
- Back
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Kidney functions
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1. Filtration - starts in glomerulus; electrolytes etc (not protein and rbcs) leave blood system into proximal tubular system to make filtrate
2. Reabsorption - when fluid and electrolytes get reabsorbed back into the blood in the tubular system 3. Secretion - urine is secreted |
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Renin-angiotensin-aldosterone pathway
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Renin gets released by kidney when perfusion to kidney is low, negative feedback loop to activate aldosterone to increase blood volume
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Effects of renin and prostaglandin on renal blood flow
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Renin = vasoconstriction
Prostaglandin = vasodilation |
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Geriatric considerations for kidneys
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•Structural kidney changes include loss of renal mass and loss of nephrons which place older adults at higher risk of renal injury
•In the normal healthy older adult these changes ALONE are not significant enough to lead to loss of renal function |
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Cause and Examples of prerenal acute kidney injury
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Cause: decreased perfusion to kidneys caused by external factor
•Hypovolemia •Effective volume depletion (fluid shifts) •Decreased cardiac output •Decreased vascular oncotic pressure •Decreased Peripheral Vascular Resistance •Decreased Renovascular Blood Flow |
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Cause and examples of intrarenal acute kidney injury
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Cause:Direct damage to kidney tissue causing impaired function of the nephron
•Acute Tubular Necrosis •Interstitial Nephritis: Allergies or Infection •Acute glomerulonephritis •Contrast induced nephropathy (CAN) |
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Cause and examples of postrenal acute kidney injury
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Cause: mechanical obstruction of urine outflow
•Benign Prostatic Hyperplasia •Prostate Cancer •Calculi •Bilateral Ureter Obstruction •Foley Blockage |
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Mechanisms of acute tubular nephrosis
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?Most common type of Intrarenal AKI
?Mechanism ?Damage to basement membrane of tubular epithelium ?Necrotic tissue sloughs off ?Tubules become blocked |
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Causes of acute tubular nephrosis
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?Prolonged prerenal or post renal failure
?Hemolyzed Red Blood Cells ?Increase in Myoglobin |
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Risk factors of Contrast induced nephropathy
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•Risk Factors:
–Dehydration, hypotension, sepsis –Concurrent use of nephrotoxic medications –Administration > 100 mL contrast –GRF < 60 ml/min –Diabetes –Age > 75 years old |
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Phases of acute intrarenal kidney injury
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Oliguric (low U output, fluid vol overload), Diuretic (inability to concentrate U and increased output, fluid volume deficit, hypoK and hyponatremia), Recovery (may take 12 months for BUN/creatinine to normalize)
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Chronic Kidney Disease (CKD)
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Stage 5 ESRD = GFR < 15ml/min
Diabetes = #1 cause of CKD Injury from CKD is because of long term compensatory mechanism of disease process, then you have loss of nephrons, glomerular hypertension, leading to proteinuria and renal scarring |
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Clinical manifestations of CKD: urinary
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1. Polyuria (low specific gravity; nocturia; comorbid DM)
2. Oliguria 3. Anuria |
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Clinical manifestations of CKD: electrolytes
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Increased K, Mg, P
Decreased Na, Ca Waste product (urea) accumulation |
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Clinical manifestations of CKD: metabolic
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Metabolic acidosis!
Buildup of urea causes changes in mental status! |
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Stages of CKD
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1. Decreased GFR
2. Increased BUN/ creatinine 3. Uremia (N/V, lethargy, thought process changes 4. Menntal status changes, parathesias, neuopathies |
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Clinical manifestations of CKD: hematological
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Anemia
-Decreased EPO, iron stores, folic acid -Increased blood loss dialyzer, Parathyroid hormone Bleeding tendencies Infections |
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Clinical manifestations of CKD: musculoskeletal
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Decreased Vit D activation and decreased P excretion cause drop in serum calcium levels which causes bone breakdown which leads to *renal osteodystrophies* (aka osteomalacia and ostetitis fibrosis together)
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Clinical manifestations of CKD: cardiovascular
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#1 cause of morbidity and mortality in CKD patients is CV event!!!
Increased risk for CV event caused by: P/Ca deposits in vascular system Longstanding HTN (caused by comorbidites and inability to excrete fluid and Na) Increased lipids (caused by comorbidities and altered metabolism) |
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Other clinical manifestations of CKD
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Uremic fector (breath)
Pruritis Uremic frost (white specs on skin) Sex dysfunction Respiratory infections |
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Diagnostics for CKD
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•History and Physical
•Identification of High-Risk Comorbidities •Urinalysis –**+ proteinuria**, microalbuminuria, RBC’s, WBC’s, protein, casts and glucose •BUN, Serum Creatinine, Creatinine Clearance •Calculated GFR •Renal Ultrasound, Renal Scan, Renal Biopsy •Lipid Profile •Complete Blood Count |
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Diagnostics for AKI
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Creatinine clearance (approximates GFR), BUN, Creatinine, **Calculated GFR** (125ml/min)
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Urinalysis results for AKI
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•Urinalysis: May be positive for casts (intrarenal failure), protein, hematuria, pyuria, alterations in urine specific gravity
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