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Questions and Answers
What is one of the primary functions of the kidneys?
What is one of the primary functions of the kidneys?
Which electrolyte has a normal range of 3.5-5.0 mEq/L?
Which electrolyte has a normal range of 3.5-5.0 mEq/L?
What hormonal function does erythropoietin serve in the body?
What hormonal function does erythropoietin serve in the body?
What condition is characterized by impaired vitamin D metabolism and poor calcium reabsorption?
What condition is characterized by impaired vitamin D metabolism and poor calcium reabsorption?
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What lab finding is typically elevated in prerenal azotemia?
What lab finding is typically elevated in prerenal azotemia?
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What can result from reduced blood flow to the kidneys without structural damage?
What can result from reduced blood flow to the kidneys without structural damage?
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What happens when erythropoietin levels are insufficient due to kidney damage?
What happens when erythropoietin levels are insufficient due to kidney damage?
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What can hypertension due to decreased kidney perfusion lead to?
What can hypertension due to decreased kidney perfusion lead to?
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What condition can lead to postrenal azotemia?
What condition can lead to postrenal azotemia?
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Which treatment is indicated for prerenal azotemia due to hypovolemia?
Which treatment is indicated for prerenal azotemia due to hypovolemia?
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What is the first step in managing intrinsic renal azotemia caused by acute tubular necrosis?
What is the first step in managing intrinsic renal azotemia caused by acute tubular necrosis?
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Which type of renal azotemia is characterized by elevated BUN-to-creatinine ratio that normalizes?
Which type of renal azotemia is characterized by elevated BUN-to-creatinine ratio that normalizes?
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Which of the following conditions can cause prerenal injury?
Which of the following conditions can cause prerenal injury?
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What is a potential consequence if postrenal obstruction goes untreated for a prolonged period?
What is a potential consequence if postrenal obstruction goes untreated for a prolonged period?
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In managing postrenal azotemia, what is the first step once the obstruction is identified?
In managing postrenal azotemia, what is the first step once the obstruction is identified?
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Which of the following is a vital component of supportive care for intrinsic renal azotemia?
Which of the following is a vital component of supportive care for intrinsic renal azotemia?
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What is the consequence of using NSAIDs like Motrin in patients with acute kidney injury?
What is the consequence of using NSAIDs like Motrin in patients with acute kidney injury?
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Which condition is characterized by decreased urinary output with mild increases in BUN and creatinine levels?
Which condition is characterized by decreased urinary output with mild increases in BUN and creatinine levels?
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In the recovery phase of acute tubular necrosis, what is typically observed regarding urinary output?
In the recovery phase of acute tubular necrosis, what is typically observed regarding urinary output?
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Which medication is classified as an osmotic diuretic and is used during acute kidney injury?
Which medication is classified as an osmotic diuretic and is used during acute kidney injury?
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What primary diagnostic test is used to identify obstructive causes of renal failure?
What primary diagnostic test is used to identify obstructive causes of renal failure?
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What is a common clinical manifestation of postrenal acute kidney injury?
What is a common clinical manifestation of postrenal acute kidney injury?
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Which of the following medications is an ACE inhibitor?
Which of the following medications is an ACE inhibitor?
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During the maintenance phase of acute tubular necrosis, which condition is likely to develop?
During the maintenance phase of acute tubular necrosis, which condition is likely to develop?
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Which type of dialysis involves the use of a peritoneal catheter?
Which type of dialysis involves the use of a peritoneal catheter?
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What specific electrolyte imbalance is commonly monitored in patients with acute kidney injury?
What specific electrolyte imbalance is commonly monitored in patients with acute kidney injury?
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Study Notes
Acute Kidney Injury
- Kidney function involves maintaining fluid and electrolyte balance, removing water-soluble waste products, regulating urine composition, and performing key endocrine functions.
- Electrolyte levels are crucial:
- Potassium: 3.5-5.0 mEq/L
- Sodium: 135-145 mEq/L
- Calcium: 8.5-10.5 mg/dL
- Phosphorus: 3.0-4.5 mg/dL
- Hormonal regulation is essential, including:
- Erythropoietin, stimulating red blood cell development and production.
- Vitamin D, important for calcium regulation.
- Osteodystrophy happens when vitamin D is impaired, causing poor calcium absorption and decreased calcium, stimulating parathyroid hormone release.
- Clinical problems include:
- Anemia due to reduced red blood cell production.
- Reduced blood flow.
- Renin-Angiotensin-Aldosterone System activation leading to hypertension, damaging glomerulus capillaries.
- Types of Azotemia (renal failure):
- Prerenal: Reduced blood flow to the kidneys (e.g., hemorrhage, dehydration). Key lab findings include elevated BUN-to-creatinine ratio (>20:1) and low urine sodium concentration.
- Intrinsic (Renal): Damage to the kidney itself (e.g., acute tubular necrosis, ATN). Key lab findings include normal or lower BUN-to-creatinine ratio and high urine sodium concentration.
- Postrenal: Blockage of urine outflow (e.g., kidney stones, enlarged prostate). Key lab findings include BUN-to-creatinine ratio that initially elevates then normalizes and high urine sodium concentration.
- Treatment Approaches
- Prerenal Azotemia: Identifying and treating the underlying cause (e.g., dehydration, heart failure) is key along with providing fluids during recovery. Also monitoring kidney function frequently and avoiding nephrotoxic drugs during recovery.
- Intrinsic Renal Azotemia: Identifying and treating the underlying cause (e.g., ATN). Removing nephrotoxic drugs, managing electrolytes, and supporting care such as hydration are essential.
- Postrenal Azotemia: Relieving the obstruction, use of catheters or surgery if needed, supporting kidney function with frequent monitoring, and managing resulting electrolyte imbalances are crucial.
- Pathophysiology:
- Prerenal Azotemia (Initiation): Blood overfills the ventricle due to damaged heart tissue. Can result from hemorrhage, dehydration, burns, heart failure, and myocardial infarction.
- Prerenal AKI: NSAIDS, Ace inhibitors, ARBs (reduce glomerular perfusion). Medications that can cause kidney damage.
- Intrarenal (Intrinsic) Azotemia: Acute tubular necrosis is the most common cause, caused by radiographic contrast media. The most common antibiotics that cause damage include certain aminoglycoside antibiotics.
- Acute Tubular Necrosis (AKI): Three phases (Initiation, Maintenance, Recovery) differing in symptoms. Initiation phase is characterized by decreased urine output, mild increase in BUN, and creatinine levels. The maintenance phase exhibits oliguria (<30 cc/hr) and fluid overload. Recovery phase shows increasing urine output (>400 cc/hr) and normalization of BUN and Creatinine levels.
- Postrenal AKI: Benign prostatic hyperplasia, kinked or obstructed catheters, intra-abdominal tumors, and calculi are common causes.
- Clinical Manifestations: Elevated blood pressure, S3 heart sound (indicating problems with left ventricular function), pulmonary crackles, jugular venous distention, and anemia are possible signs.
- Diagnostic Tests: Urinalysis, serum electrolytes, elevated serum creatinine, blood urea nitrogen, complete blood count are essential.
- Treatments:Renal Ultrasonography can help identify obstructive causes. Medications include loop diuretics (bumetanide, ethacrynic acid, furosemide, torsemide) and osmotic diuretics(mannitol, urea).
- Electrolyte Modifiers: Calcium chloride, calcium gluconate, sodium bicarbonate, sodium polystyrene sulfonate can be used to adjust electrolyte imbalances.
- Dialysis: Three main types (hemodialysis, peritoneal dialysis, continuous renal replacement therapy) to remove toxins and lower elevated drug levels.
- Hemodialysis Access: Arteriovenous fistula, arteriovenous graft, central venous catheter.
- Peritoneal Dialysis: waste products are moved into a dialysate solution and drained. Peritoneal catheter used.
- Implementation of Care: Crucial monitoring of intake and output, daily weights, assessing vital signs, and monitoring electrolytes and fluid restriction.
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Description
This quiz focuses on the key aspects of acute kidney injury, including its effects on kidney function, electrolyte balance, hormonal regulation, and related clinical problems. Participants will explore concepts like erythropoietin's role and the implications of osteodystrophy. Test your understanding of the mechanisms and consequences of renal failure.
