NSG 430 TOPIC 6
• renal trauma is almost always caused by and will present w : pen-
etrating causes - violence; gross hematuria
• acute kidney injury (AKI): rapid loss of kidney function - high mortality rate
• different types of AKI?: -prerenal
-intrarenal
-postrenal
• prerenal AKI: damange before kidneys; problem is blood flow TO kidneys
• the key s/s of a prerenal issue is : oliguria
• causes of prerenal AKI: -severe dehydration
-HF
-decreased CO
• intrarenal AKI: damage occurs inside the kidney
• causes of intrarenal AKI: -acute tubular necrosis (ATN)
-prolonged ischemia
-nephrotoxins
-lots of hgb
-lots of myoglobin
-kidney disease
• acute tubular necrosis (ATN): renal tubule damage; one of the most commoncauses of
AKI
• what causes ATN?: ischemia, nephrotoxins, sepsis
• patho of ATN: renal tubule damage (ischemia, nephotoxins, sepsis) leads totubules
sloughing off and creating clogs
• is ATN reversible: yes, potentially
• which level of AKI is ATN?: intrarenal
• post renal AKI: damage occurs after kidneys; blocks urine outflow
• causes of postrenal AKI: -bph/prostate cancer
-kidney stones
, -trauma
-extrarenal tumors
• postrenal AKI comes w an increased risk of : hydronephrosis
• for optimal outcomes, hydronephrosis should be tx within : 48
hr
• 3 phases of AKI: 1. oliguric phase
2. diuretic phase
3. recovery phase
• oliguric phase: "shut down" phase; occurs abt 1 weeks after injury (should notlast more
than 2 weeks)
• hydronephrosis: fluid backs up into kidneys --> kidney swells
• urinary tract calculi aka nephrolithiasis aka kidney stones: concentration ofsupersaturated
crystals precipiate + form stones
• types of kidney stones: -ca+ oxalate
-ca+ phosphate
-cystine
-struvite
-uric acid
• what type of kidney stone is most common?: ca+ stones
• high ph (alkaline) environment will produce stones: ca stones
• low ph (acidic) will produce: uric acid + cystine stones
• what is the FIRST s/s of kidney stone: sudden + severe pain (renal colic)
• what are the characteristics of kidney stone pain?: in the flank, back, lowerabd
• besides renal colic pain, pt w kidney stone may also have (s/s): -
N/V
-"kidney stone dance"
-dysuria
-fever/chills
-moist, cool skin
-distress
• dx studies of kidney stones: -noncontract helical (spiral) scan
• renal trauma is almost always caused by and will present w : pen-
etrating causes - violence; gross hematuria
• acute kidney injury (AKI): rapid loss of kidney function - high mortality rate
• different types of AKI?: -prerenal
-intrarenal
-postrenal
• prerenal AKI: damange before kidneys; problem is blood flow TO kidneys
• the key s/s of a prerenal issue is : oliguria
• causes of prerenal AKI: -severe dehydration
-HF
-decreased CO
• intrarenal AKI: damage occurs inside the kidney
• causes of intrarenal AKI: -acute tubular necrosis (ATN)
-prolonged ischemia
-nephrotoxins
-lots of hgb
-lots of myoglobin
-kidney disease
• acute tubular necrosis (ATN): renal tubule damage; one of the most commoncauses of
AKI
• what causes ATN?: ischemia, nephrotoxins, sepsis
• patho of ATN: renal tubule damage (ischemia, nephotoxins, sepsis) leads totubules
sloughing off and creating clogs
• is ATN reversible: yes, potentially
• which level of AKI is ATN?: intrarenal
• post renal AKI: damage occurs after kidneys; blocks urine outflow
• causes of postrenal AKI: -bph/prostate cancer
-kidney stones
, -trauma
-extrarenal tumors
• postrenal AKI comes w an increased risk of : hydronephrosis
• for optimal outcomes, hydronephrosis should be tx within : 48
hr
• 3 phases of AKI: 1. oliguric phase
2. diuretic phase
3. recovery phase
• oliguric phase: "shut down" phase; occurs abt 1 weeks after injury (should notlast more
than 2 weeks)
• hydronephrosis: fluid backs up into kidneys --> kidney swells
• urinary tract calculi aka nephrolithiasis aka kidney stones: concentration ofsupersaturated
crystals precipiate + form stones
• types of kidney stones: -ca+ oxalate
-ca+ phosphate
-cystine
-struvite
-uric acid
• what type of kidney stone is most common?: ca+ stones
• high ph (alkaline) environment will produce stones: ca stones
• low ph (acidic) will produce: uric acid + cystine stones
• what is the FIRST s/s of kidney stone: sudden + severe pain (renal colic)
• what are the characteristics of kidney stone pain?: in the flank, back, lowerabd
• besides renal colic pain, pt w kidney stone may also have (s/s): -
N/V
-"kidney stone dance"
-dysuria
-fever/chills
-moist, cool skin
-distress
• dx studies of kidney stones: -noncontract helical (spiral) scan
