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80 Cards in this Set
- Front
- Back
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1-7 days of decline in renal function is the definition of?
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abrupt acute kidney injury
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greater than 24 hours of decline inn renal function is the definition of?
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sustained acute renal injury
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urine output of less than 50 ml/day is the definition of?
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anuric
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urine output of less than 500 ml/day is the definition of?
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oliguric
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urine production greater than 500 ml/day is the definition of?
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non-oliguric
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What is the survival rate of community acquired AKI?
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70-95%
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What is the survival rate of hospital acquired AKI?
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30-50%
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What is the survival rate of ICU acquired AKI?
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10-30%
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What are the goals of AKI therapy?
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prevention, minimize further insult, supportive measures
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List some risk factors of AKI. There are 8.
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increased age
acute infection pre-existing respiratory disease pre-existing cardiovascular disease diabetes dehydration chronic renal failure drugs |
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What agents are used for prophylasis of AKI?
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sodium bicarb infusion
hydration acetylcysteine |
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Which of the following are agents without clear benefit for prophylaxis?
I. dopamine, fenoldopam II. nesiritide III. mannitol, furosemide IV. Sodium bicarb, acetylcysteine |
I, II, III
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What dose should acetylcysteine be given as prophylaxis for contrast media exposure?
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600mg PO Q12H x 4 doses at least once prior to contrast
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What should be used for hydration for prophylaxis for contrast media exposure?
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NS
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What type of regimen should be used for hydration as prophylaxis for contrast exposure?
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NS IV 1ml/kg/hr 3 hours before, during, and 8-24 hours after procedure
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What are the other uses of acetylcysteine?
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Acetameinophen overdose
mucolytic |
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This type of AKI is secondary to reduced blood delivery to kidney and occurs in the areas before kidney
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prerenal AKI
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This type of AKI is a direct insult to the structural tissue of the kidney
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intrinsic AKI
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This type of AKI is secondary to obstructed urinary output. It results from damage to areas after the kidney
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postrenal AKI
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what are the signs of AKI? There are 7
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edema
sudden wt gain JVD (jugular venous distension) change in color of urine decrease urine output changes in BP rales |
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What are the symptoms of AKI? There are 4
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flank pain
confusion loss of appetite SOB |
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What lab values indicate AKI?
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increased BUN, creatinine, phosphorus, magnesium, and potassium
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For patients with prerenal AKI, what is the fluid of choice for volume replacement?
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isotonic NS
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What dose of IV should be challenged in volume replacement for prerenal AKI?
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250-500ml over 15-30min
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What should be assessed after each bolus of volume replacement for prerenal AKI?
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lack of pulmonary or peripheral edema
adequate blood pressure normoglycemia electrolyte balance |
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How much volume replacement do most patients need for prerenal AKI?
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1-2 liters
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DKA, hyperosmolar hyperglycemic state and septic patients requires up to how much liters of volume replacement in prerenal AKI?
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10 liters in first 24 hours
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True or False: volume replacement is administered at the same rate in all patients
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False
need to use slower rehydration in patients with heart failure or pulmonary insufficiency |
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What should be used to replace blood loss in volume replacement of prerenal AKI?
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RBC transfusion to hematocrit < or = 30%
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What thiazide diuretic is used for diuretic therapy?
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metolozone
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What osmotic diuretic is used for diuretic therapy?
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mannitol
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What loop diuretics is used for diuretic therapy?
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furosemide
bumetanide torsemide |
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What are the causes of diuretic resistance? There are 4
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excessive sodium intake
acute tubular necrosis glomerulonephritis reduced renal blood flow |
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True or False: there are no clinical data showing improved outcomes in AKI patients when treated with loop diuretics
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True
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What type of patients are loop diuretics reserved for in the treatment of AKI?
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reserved for fluid-overloaded patients at risk for pulmonary edema
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True or False: loop diuretics should only be used when patients produce urine following dose?
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True
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What is a more effective form of administration of loop diuretics in treating AKI?
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continuous IV infusion
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What is the adverse reaction of loop diuretics?
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ototoxicity
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What is the maximum dose of furosemide to prevent adverse reactions?
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4mg/min
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Why should oral doses of furosemide be avoided in the treatment of AKI?
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oral doses have variable bioavailability
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What dose of furosemide should be given in the treatment of AKI?
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40-80 mg IV bolus followed by continuous IV infusion of 10-20 mg/hr initially
there are documented doses of greater than 100mg/hour in AKI |
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How soon should you expect to see an increase in urine output after administration of furosemide for the treatment of AKI?
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5-30 minutes
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True or False: Mannitol may cause AKI itself
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True
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What is mannitol only used for in the treatment of AKI?
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reserved only for cerebral edema
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What dose of mannitol should be given in the treatment of AKI?
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12.5-25 gm IV over 3-5 minutes
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What are the disadvantages of using mannitol?
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has little non-renal excretion so it may cause hyperosmolar state in patients who are anuric or oliguric
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What dose of metolozone should be used in the treatment of AKI?
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5-20 mg/day
give 30 minutes prior to loop if using intermittent dosing |
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Only this thiazide has efficacy with GFR < 20ml/min
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metolazone
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metolazone has efficacy with GFR less than what?
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< 20ml/min
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Renal replacement therapies are used in what case of AKI?
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severe cases of AKI
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What type of membranes are used to filter blood in renal replacement therapy?
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semi-permeable membrane
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In renal replacement therapy, what components remain in the blood as the blood gets filtered?
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cellular components and other solutes
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How often can intermittent hemodialysis be used?
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3 TIW or daily
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What is the disadvantage of using intermittent hemodialysis?
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may increase kidney damage from hypotension due to fluid removal and body providing the "pump"
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What are the advantages of using intermittent hemodialysis? There are 4
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machines readily available
treatment is only 3-4 hours long rapid removal of volume and solute rapid correction of electrolyte abnormalities |
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What are the advantages of using continuous renal replacement therapy? There is 2
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solute and volume correction slower but more is removed in a 24 hr period
useful in hemodynamically unstable patients |
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What are the disadvantages of using continuous renal replacement therapy? there are 4
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need specialized machines
sessions run continuosly so need more staff to run it more expensive less drug-dosing information since it is newer |
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What is required to prevent thrombosis when using CRRT?
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anticoagulants: heparin, direct thrombin inhibitor, citrate
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What is the blood flow to CRRT machine?
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100-200 ml/min
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What is the blood flow to IHD machine?
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200-400 ml/min
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What is type of renal replacement therapy have a faster blood flow to machine?
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IHD (intermittent hemodialysis)
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True or False: CRRT and IHD have the same drug dosing data
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False
You should not assume IHD data applies to CRRT |
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Because there are fewer drug-dosing information for CRRT, what should be considered when using CRRT?
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type of CRRT being used and filter properties
drug dose adjustments based on clinical data with similiar CRRT specifics Drug level to ensure appropriate levels necessary changes when CRRT is stopped |
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Sodium should be restricted to how much to prevent hypernatremia?
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3 gm/day (130 meq/day)
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What should potassium be restricted to in order to prevent hyperkalemia?
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3 gm/day from diet
removed form IV sources unless pt have documented hypokalemia |
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How can you managed hyperphosphatemia in patients receiving CRRT?
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restrict dietary intake
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How can you manage hypermagnesemia in patients receiving CRRT?
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restrict dietary intake
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How can you manage hypermagnesemia in patients receiving CRRT?
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restrict dietary intake
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hypocalcemia can result during CPPT due to what?
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Citrate used as anticoagulant
hyperphosphatemia |
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How often should fluids ins/outs be monitored in patient receiving renal replacement therapy?
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every shift
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How often should patient weight be monitored when using renal replacement therapy?
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daily
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How often should hemodynamics (BP, HR, MAP) be monitored in renal replacement therapy?
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every shift
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How often should electrolytes be monitored in renal replacement therapy?
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at least daily
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How often should BUN and creatinine be monitored in renal replacement therapy?
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daily
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What is the creatinine half life in normal patients?
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3.5 hours
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What is the creatinine half life in AKI patients?
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up to 24 hours
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Why should IHD patients limit protein intake?
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you have waste build up between treatments
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Why do you have to account for glucose in CRRT?
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CRRT replacement fluids conatin large amounts of glucose
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nitrogen waste is removed continuosly by what renal replacement therapy?
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CRRT
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True or False: renal replacement therapy does not remove protein
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False
renal replacement therapy do remove protein |
