ATI Acute Kidney Injury and Chronic
Kidney Disease// ATI PN
COMPREHENSIVE EXIT EXAM RETAKE
2023- 2024 WITH NGN QUESTIONS
(ACTUAL EXAM)
Acute Kidney Injury Patho- Prerenal - ✔✔ANSWER✔✔>>- external to the
kidneys
- reduce systemic circulation causing reduction in renal blood flow=
decease glomerular perfusion and filtration of kidneys
Acute Kidney Injury/ Acute Kidney Failure- what is it - ✔✔ANSWER✔✔>>-
term used to encompass entire range of syndrome
- from slight deterioration of kidney function to severe impairment
- characterized by a rapid loss of kidney function
- this loss is accompanied by a rise in serum creatinine and or reduction in
urine output
- can develop to progressive azotemia- accumulation of nitrogenous wastes
in the blood
- although potentially reversible, high mortality rate
- most commonly, affects people with other life threatening conditions
Complications of transplantation list - ✔✔ANSWER✔✔>>- rejection
- infection
- CVD
- malignancies
- recurrence of original kidney disease
- corticosteroid related complications
,Complications of transplantation- cardiovascular disease -
✔✔ANSWER✔✔>>- transplant recipients have increased incidence of
atherosclerosis vascular disease
- hypertension, dyslipdemia SM rejection --> CV disease
- immunosuppressants can worsen hypertension and dyslipdemia
Complications of transplantation- corticosteroid complications -
✔✔ANSWER✔✔>>- aseptic necrosis of hips, knees and other joints can
result form chronic corticosteroid therapy
- or peptic ulcer
- in first year after transplantation, corticosteroid doses are usually
decreased 5-10mg/day
- many transplant programs have initiated corticosteroid free drug
regiments because of problems
Complications of transplantation- infection - ✔✔ANSWER✔✔>>sig cause
of dying after
- because of suppression of boys normal defense mechanisms by surgery,
immunosuppressive drugs and effects of ESKD
- underlying illness like DM, malnutrition, older age can further complicate -
- most common observed in first month- pneumonia, wound infection, IV
lien drain infections, UTI
- fungal and viral are not uncommon because immunspresed state
- fungal difficult to treat
- viral- CMV, Epstein Barr, herpes
- CMV is one most common viral- if recipient has never had CMV and
receives an organ from a donor with history CMV antiviral prophylaxis will
be administered
Complications of transplantation- malignancies - ✔✔ANSWER✔✔>>-
greater then general population because immunosuppressive therapy
- most common basal squamous cell carcinoma of skin, Hodgkin's and NHL
- screening for cancer is important
Complications of transplantation- recurrence of original kidney disease -
✔✔ANSWER✔✔>>- occurs in some
- most common with glomerulonephritis, immunoglobin A nephropathy,
diabetic nephropathy
- must be advice is can happen
,Complications of transplantation- rejection - ✔✔ANSWER✔✔>>one of
major problems
- can by acute or chronic
- should be put on transplant list hope can be retransplanted before dialysis
is required
Continuous Ambulatory Peritoneal Dialysis- CAPD - ✔✔ANSWER✔✔>>-
done while the patient is awake during the day
- exchanges are carried out manually be exchanging 1.5-3L of peritoneal
dialystate at least 4x a day with dwell timings emerging 4 hours
- disposable plastic tube
-in CAPD the bag and line can be disconnected after the instillation of fluid
- after the equilibration period, the line is reconnected to the catheter and
the dialystate is drained from the peritoneal cavity, and a new 2-3L bag of
dialystate is infused
Contraindications for kidney transplant - ✔✔ANSWER✔✔>>- disseminated
malignances
- refractory or untreated cardiac disease
- chronic respiratory failure
- extensive vascular disease
- conrhonc infection
- psychologic disorders- nonadherence ot medical regiments, alcoholism,
drug addition
- at one time HIV people were denied opportunity, now centers have
included HIV patients
- the presence of hepatitis B or C is NOT a contraindication
Note
- sometimes surgical procedures are required before transplantation-
coronary artery bypass or angioplasty may be indicated etc.
*in general, the recipient's own kidneys do not need to be removed before
he or she receive transplant
Contraindications of PD her list - ✔✔ANSWER✔✔>>- history of multiple
abdominal surgical procedures or severe abnormal pathology
- recurrent abdominal wall or inguinal hernias
- excessive obesity with large abdomen wall and fat deposits
- pre-existing vertebral disease- chronic back problems
, - severe obstructive pulmonary disease
Acute Tubular Necrosis - ✔✔ANSWER✔✔>>= most common intrarenal
cause of Aki and is primarily result of ischemia, nephrotoxins or sepsis
- severe kidney ischmeia causes a disruption in the basement membrane
and patchy destruction of the tubular epithelium
- nephrotoxic agents cause necrosis of tubular epithelial cells, which slough
off and plug the tubules
- ATN is potentially reversible if the basement membrane is not destroyed
and tubular epithelium regretters
- ATN is most common cause of AKI for hospitalized patients
AKI Acute Intervention - ✔✔ANSWER✔✔>>- manage fluid and electrolyte
balance during oliguric and diuretic phases
- observe and record I/O
- daily weights at the same time to detect gains or loss 1kg = 1000mL of
fluid
- assess for s/s of hypervolemia in oliguric phase or hypovolemia in diuretic
phase
- infection is the leading cause of death in AKI, aseptic technique is
CRITICAL- protect patient- be alert for local manifestations of infectin-
swelling, redness pain, and systemic- fever, malice, but realize temp may
NOT always be elevated
- patients with kidney failure have a blunted febrile response to an infection
- if antibiotics are used to treat the infection, dose and frequency must be
considered because kidneys are primary route of excretion for many
antibiotics
- perform skin care and mouth care to prevent stomatitis - painful swelling
and sores in the mouth
AKI Care - ✔✔ANSWER✔✔>>-eliminate cause managemt symptoms
- first step is to determine if there is adequate intravascular volume and
cardiac output to ensure adequate perfusion to the kidneys
- diuretic therapy is often administered but NOT recommended in high
doses
- usually loop diuretic- Lasix (act on ascending loop of Henle) or an osmotic
diuretic- mannitol
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