Acute Kidney Injury - IST 2 EXAM 1

Pre renal AKI occurs in the _____

afferent and efferent arteriole

pre renal AKI occurs due to ______

THINK ____ AND ______

• volume depletion

• deceased blood flow to the kidneys

Think VOLUME AND TONE

pre renal AKI leads to _____ blood flow → _______ renal perfusion → _______ GFR

DECREASED blood flow → DECREASED renal perfusion → DECREASED GFR

How does the body compensate to restoe volume restore due to pre renal AKI

increases Na+ and H20 retention

TRUE OR FALSE
There is structural damage to the nephron in PRERENAL AKI

NO STRUCTURAL DAMAGE

Prerenal AKI is reversible if caught early

Volume causes of prerenal AKI include

• dehydration

• GI loss (removal of electrolyte and dehydration)

• blood loss

• burns

FLOW causes of pre renal AKI

• heart failure

• diabetes related vascular disease

• sepsis

• acute hypotension

PRE RENAL AKI

What medication group may vasocontsrict afferent arteriole

What does this lead to?

NSAIDS

Decrease in GFR

ACUTE PRE RENAL AKI

What medication group may vasodilate efferdent arteriole?

What does this lead to?

ACE inhibitors / ARBS

Leads to a DECREASE in hydrostatic pressure WHICH LEADS to a DECREASE IN GFR

ACUTE PRE RENAL AKI

What medication group may cause volume depletion which may lead to PRE RENAL AKI

Diuretics

What are managment options for PRE RENAL AKI?

• HOLD medications causesing it (NSAIDS, ACEi/ARBS, Dieurtics)

• HYDRATE AND RESTORE NA WITH IV FLUID

  • LS (lacted ringers) or NS (Normal Saline)

  • KDIGO prefers crystalloid LS over NS in most AKI

• Counsel on hydration importance and urine monitoring post discharge

Intrarenal/Intrinsic AKi involved _____ damage

intratubular damage

• direct structural damage to the kidneys

What are the three types of intrinsic/intrarenal AKI?

• give percent of each

• Acute interstitial nephritis (10%)

• Acute tubular necrosis (85%)

• glomerulonephritis (5%)

Intrinsic/intrarenal AKI includes structure damage to the ______,______,______

intrinsic/intrarenal AKI includes structural damage to the

• glomerulus

• interstitum

  OR

• tubulules

Intrarenal AKI leads to ______necrosis

renal cell necrosis

What is the renal cell necrosis, caused by intrarenal AKI , caused by?

• ischemia (decreased blood flow)

• infection or immune response

what can ischemia, infections, or immune response cause

INFLAMMATION or KIDNEY INJURY

Postrenal AKI involves ______Uropathy

obstructive uropathy

physical obstruction

Causes of Post Renal AKI?

• Kidney calculi (kidney stones)

• blood clots

• benign prostatic hypertrophy (BPH)

• Malignancy (prostate, bladder, cervical)

• pregnancy

• Drug induced crystal obstruction (Acyclovir, methotrexate, indinavir)

Physical obstruction in Postrenal AKI creates pressure on the _______ systems causing decrease in:

• —

• __

• __

Physical obstruction in the postrenal AKi causes INCREASE pressure on the kidney systems which causes DECREASE in:

• GFR

• NA and H20 reabsorption

What happens when there is prolonged POSTRENAL AKI?

May lead to ATN - Acute tubulor necrosis

Managment of Postrenal AKI

• Decrease obstruction (foley catheter, stent, nephrostomy)

• DC (discontinue) invasive drug IF DRUG INDUCED

• Treat underylying issues (kidney stones, BPH, malagnincy)

• RRT if unresponsive to above steps