Patient Case Study - Acute Kidney Injury (AKI)
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What does a creatinine level of 139.82 mmol/L indicate about the patient's kidney function?

  • It indicates significant kidney impairment. (correct)
  • It shows signs of mild dehydration.
  • It reflects chronic kidney disease.
  • It suggests normal renal function.

    • What is the normal range for blood urea nitrogen, based on the values presented?

  • 5.0 - 7.0 mmol/L (correct)
  • 8.0 - 10.0 mmol/L
  • 0.5 - 1.0 mmol/L
  • 3.0 - 5.0 mmol/L

    • What does the thicken bladder wall imply regarding the patient's condition?

  • It suggests the presence of a bladder tumor.
  • It can indicate cystitis. (correct)
  • It indicates healthy bladder function.
  • It reflects an acute kidney injury.

    • What is a potential consequence of not managing the patient's condition properly?

    <p>Acute kidney injury.</p> Signup and view all the answers

    How is the blood urea nitrogen level interpreted in relation to the creatinine level?

    <p>It contradicts the implication of impaired kidney function.</p> Signup and view all the answers

    What should be monitored and potentially supplemented in AKI patients on CRRT?

    <p>Zinc, selenium, and copper</p> Signup and view all the answers

    Why is it important to supplement water-soluble vitamins in AKI patients undergoing RRT?

    <p>Due to potential losses during RRT</p> Signup and view all the answers

    When adjusting nutrition support for AKI patients, what metabolic markers should be monitored?

    <p>Urea and creatinine</p> Signup and view all the answers

    What is the mechanism of action for Furosemide?

    <p>Inhibits Na-K-Cl cotransporters</p> Signup and view all the answers

    What side effects may be experienced from taking Losartan?

    <p>Pain in joints or muscles, nausea</p> Signup and view all the answers

    What is the first step in managing an oxygen saturation level of 88% in a patient?

    <p>Provide supplemental oxygen</p> Signup and view all the answers

    Which medication class does Furosemide belong to?

    <p>Loop diuretics</p> Signup and view all the answers

    What adjustment should be considered for a patient on CRRT compared to IHD?

    <p>Adjust electrolyte intake</p> Signup and view all the answers

    What is the recommended daily caloric intake for critically ill patients with acute kidney injury (AKI)?

    <p>25–30 kcal/kg/day</p> Signup and view all the answers

    When should protein intake be increased to 1.2–1.5 g/kg/day for patients with AKI?

    <p>When on Intermittent Hemodialysis (IHD)</p> Signup and view all the answers

    What percentage of total energy intake should fat constitute for critically ill patients?

    <p>30-40%</p> Signup and view all the answers

    What is the primary consideration in adjusting nutritional guidelines for patients with AKI?

    <p>Patient factors such as comorbidities</p> Signup and view all the answers

    How often should electrolyte levels such as Calcium and Magnesium be monitored in patients on RRT?

    <p>Frequently</p> Signup and view all the answers

    What is the preferred route of feeding for patients with functional gastrointestinal tracts?

    <p>Enteral Nutrition (EN)</p> Signup and view all the answers

    What should fluid intake be adjusted according to in patients with AKI?

    <p>Patient’s volume status</p> Signup and view all the answers

    What should be limited in patients with AKI to avoid fluid overload?

    <p>Sodium intake</p> Signup and view all the answers

    What is a common symptom associated with pre-renal acute kidney injury (AKI)?

    <p>Poor skin turgor</p> Signup and view all the answers

    Which condition is least likely to cause intrinsic renal acute kidney injury?

    <p>Liver disease</p> Signup and view all the answers

    What symptom indicates a potential glomerular issue related to acute kidney injury?

    <p>Foamy urine</p> Signup and view all the answers

    Which of the following would NOT be a typical sign of volume overload in a patient?

    <p>Poor skin turgor</p> Signup and view all the answers

    What is the primary cause of acute kidney injury (AKI) during the maintenance phase?

    <p>Persistent intrarenal vasoconstriction</p> Signup and view all the answers

    What is a typical symptom of liver disease?

    <p>Ascites</p> Signup and view all the answers

    Which of these conditions is most likely to exacerbate kidney injury due to medication?

    <p>Hypotension</p> Signup and view all the answers

    In which segment of the nephron is ischemic injury most prominent during the initiation phase of intrinsic AKI?

    <p>Proximal tubule</p> Signup and view all the answers

    What symptom could indicate rhabdomyolysis in a patient?

    <p>Muscle tenderness</p> Signup and view all the answers

    Which condition is contraindicated for the use of ACE inhibitors?

    <p>Bilateral renal artery stenosis</p> Signup and view all the answers

    Which of the following symptoms is most characteristic of glomerular disease?

    <p>Periorbital edema</p> Signup and view all the answers

    What phenomenon occurs due to the accumulation of nitrogenous waste products in AKI?

    <p>Retention of waste products</p> Signup and view all the answers

    What triggers the release of vasodilator prostaglandins during mild hypoperfusion?

    <p>Activation of baroreceptors</p> Signup and view all the answers

    In the recovery phase of AKI, which cells are particularly involved in repair and regeneration?

    <p>Tubular epithelial cells</p> Signup and view all the answers

    Which factor is NOT a contributor to the pathophysiology of post-renal AKI?

    <p>Volume depletion</p> Signup and view all the answers

    What effect does calcium have on tubules during nephrotoxic AKI?

    <p>Tubular obstruction</p> Signup and view all the answers

    What characterizes the extension phase of ischemic AKI?

    <p>Continual ischemic injury and inflammation</p> Signup and view all the answers

    How does obstruction during post-renal AKI initially affect renal blood flow?

    <p>It modestly increases RBF</p> Signup and view all the answers

    What type of agents can provoke AKI due to direct toxicity to tubules?

    <p>Antibiotics and anti-cancer drugs</p> Signup and view all the answers

    What is a potential outcome of continuous ischemic injury in GFR stabilization during AKI?

    <p>Progressive renal failure</p> Signup and view all the answers

    What is the primary purpose of inserting a needle under the skin to drain a cyst?

    <p>To puncture and drain the fluid</p> Signup and view all the answers

    What should be monitored when continuing the use of Losartan?

    <p>Renal function</p> Signup and view all the answers

    Which medication is recommended only when lab results indicate metabolic acidosis?

    <p>Sodium Bicarbonate</p> Signup and view all the answers

    What is the recommended dosage of Nitrofurantoin for a male with uncomplicated cystitis?

    <p>100 mg PO twice daily</p> Signup and view all the answers

    Why should NSAIDs be avoided in patients with renal complications?

    <p>They can further impair renal function</p> Signup and view all the answers

    What lab test is recommended to evaluate early signs of kidney damage?

    <p>Urinary protein screening</p> Signup and view all the answers

    What is the main rationale for maintaining blood pressure in patients with chronic kidney disease?

    <p>To slow CKD progression</p> Signup and view all the answers

    In which scenario is it essential to request electrolyte levels for a patient?

    <p>To monitor for hyperkalemia and hyponatremia</p> Signup and view all the answers

    What condition is Nitrofurantoin indicated for in a patient with adequate renal function?

    <p>Cystitis</p> Signup and view all the answers

    What is a potential consequence of not avoiding nephrotoxic agents?

    <p>Progression to acute kidney damage</p> Signup and view all the answers

    Study Notes

    Patient Case Study - Acute Kidney Injury (AKI)

    • Patient: 61-year-old Filipino male, 70kg, 165cm
    • Presenting Symptoms: Shortness of breath, chest pain, and lower extremity edema
    • Vital Signs: Blood pressure 120/80 mmHg, pulse rate 92 beats/min, respiratory rate 40 breaths/min, O2 saturation 88%, body temperature 36.4°C
    • Medical History: Smoker, hypertensive, on Losartan 100mg daily, no previous surgeries, currently works as a manager, primarily eats fast food.
    • Laboratory Results: Elevated blood urea nitrogen (5.64 mmol/L), elevated creatinine (139.82 mmol/L), few in urinalysis, hemoglobin 15.6 g/L, hematocrit 48%, RBC 5.0 x 108/uL, WBC 6.2 x 103/mm3, neutrophils 61%, lymphocytes 33%, monocytes 2.4%, eosinophils 3%, STAB 3.9%, basophils 0.5%, platelets 411x10/mm3.
    • Kidney Ultrasound Results: Kidneys normal size, bilateral renal cysts (0.5x0.5 cm and 0.2x0.5 cm cyst on upper and lower third regions)
    • Urinary Bladder Ultrasound Results: Thickened bladder wall, cystitis (48.07cc bladder volume)

    AKI Classification and Staging

    • AKI Definition: An abrupt decrease in kidney function; includes patients with or without actual kidney damage but with functional impairment relative to physiologic demand (defined within 48 hours or 7 days).
    • Etiology: Prerenal (decreased renal perfusion), intrinsic (damage to kidney tissue), and postrenal (obstruction to urine flow)
    • Classification Systems: KDIGO, AKIN, and RIFLE systems classify severity of AKI based on serum creatinine (SCr) and urine output. These systems quantify the severity and progression of AKI by categorising them, which includes Risk (R), Injury (I), Failure (F), Loss (L), and End-stage Kidney Disease (ESKD) (which are used to categorize AKD over 3 months)
    • AKI Progression: Acute Kidney Injury (AKI) can progress to acute kidney disease (AKD) if impairment remains beyond 7 days, or to chronic kidney disease (CKD) if the duration exceeds 90 days.

    Other Important Information

    • Differential Diagnoses: Based on patient's history, symptoms, and findings, potential causes leading to AKI need to be considered.
    • Nutritional Considerations: Dietary management, especially sodium, potassium, and water restrictions, might play a role in AKI managing. Protein intake might need careful consideration in AKI cases
    • Medication Review: Medications potentially interfering with kidney function (e.g., NSAIDs) should be noted, and proper management strategies for medications should be implemented.

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    Related Documents

    06 - LAB 9 Acute Kidney Injury PDF

    Description

    This quiz presents a detailed case study of a 61-year-old male patient experiencing acute kidney injury (AKI). Participants will analyze symptoms, vital signs, medical history, laboratory results, and ultrasound findings. Understanding such comprehensive case studies is essential for healthcare professionals.

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