AKI
Definition of AKI
Rapid loss of kidney function
What is CKD
Progressive, Irreversible loss of kidney function
Which lab is most specific to kidneys
Creatinine
Which phase of AKI are diuretics used. Also example of a med?
Oliguric
Furosemide (Lasix)
Bumetanide (Bumex)
The two methods of dialysis
Peritoneal and Hemodialysis
Examples of Pre-Renal causes of AKI
Hypovolemia: dehydration, hemorrhage
Decreased CO: dysrhythmia, HF, MI
Decreased PVR: anaphylaxis, neurogenic injury
Causes of CKD
Diabetes, HTN, Glomerulonephritis, Cystic Kidney Diseases
BUN of Kidney Failure, ESRD
<15
Put in order: polystyrene sulfonate, insulin with glucose, calcium gluconate
1. Calcium gluconate
2. Insulin with glucose
3. Polystyrene sulfonate
What does the GFR have to be for dialysis to be initiated?
< 15/min
Examples of Intra-renal causes
Pre-renal ischemia
damage d/t nephrotoxins
Untreated HTN
Pyelonephritis
Acute tubular necrosis
Preferred measure to determine kidney function of CKD (its a lab!)
GFR
Normal BUN
10-20
Go to medication for CKD (it relates to a lab)
Phosphate Binders
When is Emergent Hemodialysis considered?
Extreme cases of AKI. Volume overload compromising heart/lungs
Post-Renal Cause
Obstruction of urinary outflow
Tumors
Strictures or stones
Hydronephrosis
Dietary restrictions. Which labs are important to educate the patient on?
Potassium, Phosphate, Sodium
Which labs are typically elevated? (can name any!)
Potassium
BUN
Creatinine
Sodium
Phosphate
How is calcium gluconate effective in mgmt of elevated K+?
Protection of the heart for the effects of high K
Last resort option for ESRD
Transplant
Oliguric --> Diuretic --> Recovery
How do we know the fluid restrictions for said patient? (equation!!)
output from previous day + 600 mL
Normal Creatinine
0.5-1.3
What do you assess before administering Kayexalate?
Bowel sounds
Vascular access sited in hemodialysis
AV fistulas and AV graft