Topic 9 Urologic, Renal, Male Reproductive

• What is azotemia?

  Accumulation of nitrogenous waste products (urea nitrogen, creatinine) in the blood.
• Intrarenal causes of AKI are problems that cause direct damage to kidney tissue.
• What are some intrarenal causes of AKI?

  Acute glomerulonephritis, systemic lupus erythematosus (SLE).
• What are post renal causes of AKI?

  Obstruction, kidney stones, tumors, or enlarged prostate (BPH).
• What is a prerenal cause of AKI?

  Dehydration. Anything that reduces systemic circulation causing decreased renal blood flow.
• Acute tubular necrosis (ATN) is the most common intrarenal cause of AKI in hospitalized patients.
• What is oliguria?

  Decreased urine output of less than 400 mL/day.
• What physiologic change is associated with acute kidney injury?

  Hyponatremia since damaged tubules cannot conserve sodium.
• Hemolytic blood transfusion is an intrarenal cause of AKI.
• Intrarenal causes of AKI are problems that cause direct kidney tissue damage that lead to impaired nephron function.
• The best serum indicator of AKI is creatinine since it is not affected by other factors.
• During AKI, potassium levels increase because the secretion ability of the kidneys is impaired.
• Patients with AKI should not increase potassium intake.
• In the oliguric phase of AKI, potassium levels are elevated but sodium levels are either normal or diminished.
• Postrenal causes of AKI that cause mechanical obstructions can lead to hydronephrosis.
• What is hydronephrosis?

  Kidney swelling or dilation.
• Sodium polystyrene sulfonate (Kayexalate) and dialysis can remove potassium rapidly from the body.
• For a fluid volume overload patient with AKI, loop diuretics or osmotic diuretics like Mannitol can promote diuresis and block water reabsorption.
• What is diuresis?

  Increased urine production.
• Severe metabolic acidosis in AKI patients can lead to Kussmaul respirations to compensate for the acidosis.
• Renal calculi, benign hypertrophic hyperplasia (BPH), and spinal cord disease are all postrenal causes of AKI.
• Thrombotic disorders and malignant hypertension are intrarenal causes of AKI.
• For an acidotic patient with hyperkalemia, sodium bicarbonate may be prescribed.
• For a patient in the oliguric phase of AKI, restricting fluids according to previous daily loss is recommended.
• The general rule for calculating fluid restriction is to add all losses for the past 24 hours plus another 600 mL for insensible losses.
• Sodium polystyrene sulfonate removes 1 mEq of potassium per 1 gram of the drug.
• Sodium polystyrene sulfonate can be given by mouth or retention enema.
• Sodium polystyrene sulfonate produces osmotic diarrhea, which lets out potassium rich stool.
• Do not give Sodium polystyrene sulfonate to a patient with paralytic ileus since bowel necrosis can occur.
• When taking care of a patient with an AKI in the oliguric phase, give thorough skin care to prevent pressure injuries due to lack of mobility, wash the mouth frequently to prevent stomatitis, and assess for signs of hypervolemia.
• Why is IV insulin and IV glucose given for a patient with AKI?

  Treat hyperkalemia with insulin and prevent hypoglycemia with glucose.
• IV insulin can treat hyperkalemia by shifting potassium into the cells which decreases serum potassium levels.
• Diagnostic studies using contrast media gadolinium is not advised in patients with kidney failure since it can be fatal.
• Contrast induced nephropathy happens when contrast is used for diagnostic studies causing nephrotoxic injury.
• Metformin should be held for 48 hours before a diagnostic test with contrast to decrease the risk of lactic acidosis.
• Sodium polystyrene sulfonate has the most rapid effect for AKI.
• When a patient with kidney disease undergoes a diagnostic study where contrast is being used, provide plenty of fluids because the patient needs optimal hydration and the lowest dose of contrast.
• For an AKI patient with recent significant weight gain and oliguria, monitoring the cardiac status is the priority because of serum potassium levels being increased.
• Peritoneal membranes in PD allow passage of amino acids, polypeptides, and plasma proteins.
• Solutes from higher to lower solution is diffusion.