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NUR 325 ( LATEST 2024 / 2025 ) WEEK 11 | GRADED A+ QUESTIONS & ANSWERS
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NUR 325 ( LATEST 2024 / 2025 ) WEEK 11 | GRADED A+ QUESTIONS & ANSWERS
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NUR 325 Week 111. Acute kidney injury (AKI)
Answer
- May be referred to as acute renal failure (older term)
- Abrupt decline in kidney function leading to
1. Increased serum creatinine and/or
2. Decreased urine output
- Usually develops over hours to days with progressive elevations of BUN, creatinine & potassium
with or without oliguria (urine output <400 mL/24 hrs or <30 mL/hr)
2. 3 categories of AKI
1. Pre-renal (occurs before the kidneys)
causes that lead to renal hypoperfusion (ex. hypovolemia)
2. Intra-renal
causes that affect the renal tissue directly (intrinsic)
3. Post-renal
involves obstruction of the urinary tract; problem w/ urine leaving (after leaving the kidneys)
3. Pre-renal AKI and hypovolemia
Answer
Related to factors that reduce renal blood flow leading to decreased glomerular perfusion and
filtration
- Most common cause is hypovolemia (ex. hypotension)
,a) Causes decrease in CO, which causes ->
1. Release of angiotensin II and aldosterone, which leads to sodium & water retention ->
2. Decreased urine output ->
3. Decreased filtration leads to accumulation of waste products in the blood (azotemia)
a) Azotemia refers to elevated creatinine & blood urea nitrogen
4. Other pre-renal causes of AKI
Answer
1. Vasoactive medications
a) Ex. ACE inhibitors, ARBs, epinephrine, dopamine
b) Cause renal vasoconstriction -> hypoperfusion of the glomeruli
2. NSAIDs and radiocontrast agents
a) These medications can cause renal vasoconstriction leading to hypoperfusion of the glomeruli
*AKI associated with pre-renal causes is usually reversible
*Pre-renal AKI can progress to intra-renal disease if not corrected (must be given fluids to
reverse pre-renal AKI
5. Intra-renal causes of AKI
Answer
- Conditions that cause direct damage to the renal tissue
- Causes include
1. Acute tubular necrosis (most common cause)
2. Glomerulonephritis
inflammation of the glomerulus
3. Vascular causes
ex. renal vein thrombosis or renal infarction - obstruct the kidney
4. Interstitial disease
, infection of the interstitial tissue (such as from infection, or tumor growth)
5. Nephrotoxins
Answer
things that are toxic to the kidneys such as radiocontrast agents, some antibiotics
(aminoglycosides, gentamicin, tobramycin), NSAIDs
6. Acute tubular necrosis causes
Answer
Primarily due to
1. Ischemia (#1 cause)
less blood and oxygen delivered to the nephron -> causes epithelial cells that line the tubules to
be damaged or destroyed, causing them to slough off -> can create an obstruction -> decreases
GFR and increases pressure in tubules -> oliguria develops b/c less fluid can get through ->
products that normally get excreted get reabsorbed
2. Nephrotoxins
directly damage epithelial cells in the tubules, causing the same process in ischemia to occur
7. Acute tubular necrosis can be reversible if
Answer
1. Ischemia is not prolonged and is stopped
2. Basement membrane of the glomerulus is not destroyed
3. Tubular epithelium regenerates
8. Post-renal causes of AKI
Answer
- These involve an obstruction of urinary outflow (involving ureters, bladder, urethra)
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