an increase in SCr lags behind kidney injury; delaying diagnosis
What is the problem with using SCr as a biomarker for AKI?
excreted Na/ filtered Na x 100
FeNa formula?
> 1%
Intrinsic AKI FeNa =
hyperkalemia, hyperphosphatemia, hypocalcemia
What electrolyte abnormalities can occur in AKI? (3)
hemodynamic support and volume replacement
How do we manage/treat Pre-Renal AKI?
managing the cause and providing supportive care
How do we manage/treat Intrinsic AKI?
removing the cause of the obstruction
How do we manage/treat Post-Renal AKI?
increase dose of loop diuretic; loop diuretics + metalozone
How can we manage diuretic resistance in a volume-overloaded patient with AKI?
a
Which would be used in a hemodynamically unstable patient?
a) continuous RRT
b) intermittent RRT
discontinue drug and other potential nephrotoxins; ensure patient is hydrated
How is AG induced Tubular Necrosis treated? (2)
amifostine, antioxidants, hypertonic saline, IV magnesium
How can we prevent Cisplatin induced Tubular Necrosis? (4)
plasmaforesis; stop drug/reduce dose + vigorous hydration w NS
How is Cisplatin induced Tubular Necrosis treated? (2)
activates TNF-a which leads to renal tubular cell death; causes damage to vascular- decreased O2 delivery and cell death
How does Cisplatin cause AKI? (2)
false; it is highly protein bound and requires plasmaphoresis
Cisplatin can be removed with dialysis. T/F?
acetylcysteine, amifostine
Which drugs can we use to treat Cisplatin overdose? (2)
a
Which is a prodrug?
a) amifostine
b) acetylcysteine
high BUN, metabolic acidosis, decreased GFR
How can Lisinopril cause AKI? (3)
diabetic; they already have elevated glomerular capillary pressure due to albumin
Which patients can we use Lisinopril to treat AKI? Why?
drink lots of fluids, sodium bicarbonate, ascorbic acid, K-phos OG
How can we prevent Indinvair/ Methotrexate crystals from being formed? (4)
rhabdomyolysis
What are elevated levels of creatine kinase indicative of?
a
Which dose targets "dopamine receptors of the kidney"?
a) 1-3 mcg
b) 3-10 mcg
c) > 10
b
Which dose targets beta receptors?
a) 1-3 mcg
b) 3-10 mcg
c) > 10
c
Which dose targets alpha & beta receptors?
a) 1-3 mcg
b) 3-10 mcg
c) > 10
false; high dose to increase perfusion
Renal dose dopamine is recommended in treating AKI. T/F?
Ethyol
Amifostine Brand Name?
acid-base abnormalities, electrolyte imbalance, intoxication, fluid overload, uremia
What are the indications for starting hemodialysis? (5)