Acute Kidney Injury and Renal Replacement Therapy Lecture

Flashcards covering clinical manifestations, pathophysiology stages, treatments, dialysis types, and transplant considerations for Acute Kidney Injury and Renal Replacement Therapy.

What is the rationale behind removing race-based eGFR adjustments?

The historical adjustment delayed renal treatment for Black Americans; removing it allows more Black Americans to reach diagnostic thresholds for CKD, nephrologist referrals, and transplant eligibility earlier.

What percentage of patients admitted to ICUs develop Acute Kidney Injury (AKI)?

$$67\%$$

Which modifiable risk factor is identified as the number one cause of AKI in hospitalized patients?

Sepsis

How is prerenal AKI defined?

AKI caused by reduced renal blood flow leading to decreased glomerular perfusion and filtration.

What condition is responsible for $90\%$ of intrarenal AKI cases?

Acute tubular necrosis (ATN)

List four causes of postrenal AKI (obstruction to urine outflow).

Benign prostate hyperplasia (BPH), prostate cancer, calculi, and extrarenal tumors.

What characterizes the initiating stage of AKI?

Decreased perfusion resulting in the initiation of the RAAS, decreased urine output, high urine specific gravity, and low urine sodium concentration.

Define the clinical parameters of the oliguric phase of AKI.

Urine output $< 400\,ml/day$, fixed urine specific gravity of $1.010$, and high urine sodium ($> 40\,mEq/L$).

What occurs during the diuretic phase of AKI?

The cause of AKI is corrected, leading to osmotic diuresis ($1-5\,L/day$) due to high urea levels, which can cause dehydration and electrolyte imbalances.

What is the goal of administering calcium gluconate IV for a patient with elevated potassium?

To stabilize the myocardial cell membrane to prevent arrhythmias.

How does the administration of $D50$ followed by regular insulin IV treat hyperkalemia?

It enhances the cellular uptake of potassium by moving it from the vascular space into the cells.

Why is Kayexalate contraindicated in patients with a paralytic ileus?

It can cause necrosis of the ileus.

In Renal Replacement Therapy (RRT), what is 'Ultrafiltration'?

A subtype of filtration utilizing pressure to separate small solutes and water from blood across a semipermeable membrane based on solute size.

What are the indications for initiating RRT regarding GFR and BUN levels?

Glomerular filtration rate (GFR) $< 10\,mL/min$ and BUN between $60-120\,mg/dL$.

Describe an Arteriovenous (AV) Fistula.

A surgical anastomosis of a native artery to a native vein, often in the non-dominant arm, which requires weeks to months to mature before use.

What is Disequilibrium Syndrome in the context of hemodialysis?

A complication caused by rapid changes in extracellular fluid composition compared to the CSF, leading to cerebral edema, nausea, confusion, and seizures.

Why is Continuous Renal Replacement Therapy (CRRT) preferred for critically ill patients over traditional hemodialysis?

It allows for slow, continuous fluid removal ($100-200\,mL/hr$) which is better tolerated by patients with unstable hemodynamics.

What are the three phases of the Peritoneal Dialysis (PD) process?

Fill (infusing sterile dialysate), Dwell (fluid/solute removal via diffusion and filtration), and Drain (removing the fluid).

What are the absolute contraindications for receiving a renal transplant?

Active malignancy, active infection, active substance use disorder, untreated psychiatric disorder, and inability to tolerate surgery due to severe cardiac or pulmonary disease.

Which type of kidney donation offers the best graft and recipient survival?

Living kidney donation

What initial nursing assessment is critical following a renal transplant regarding urine output?

Monitoring hemodynamics and replacing urine $cc$ for $cc$ initially as diuresis is expected.

Why is anemia a common manifestation of renal failure?

It is related to the kidneys' inability to produce adequate Erythropoietin (EPO).