1. Discuss the treatment and prevention of Contrast Induced Nephropathy
2. Identify the characteristic symptoms and signs of your patient with oliguria
3. Identify the cause of Prerenal, post-renal, and intrarenal AKI
4. Identify which patient would be a candidate for hemodialysis treatment
5. Identify the normal and abnormal findings on a urinalysis screen

 

1. Discuss the treatment and prevention of Contrast Induced Nephropathy

Prevention is the cornerstone of contrast-induced nephropathy (CIN) management, and hydration therapy is the cornerstone of CIN prevention. Intravascular volume expansion maintains renal blood flow, preserves nitric oxide production, prevents medullary hypoxemia, and enhances contrast elimination. 

CIN Treatment includes the following :

A. Sodium bicarbonate - alkalinizes the renal tubular fluid and thus prevents free radical injury.

B. N-acetylcysteine (NAC) - NAC is acetylated L-cysteine, an amino acid. Its sulfhydryl groups make it an excellent antioxidant and scavenger of free oxygen radicals and enhances the vasodilatory properties of nitric oxide.

C. Statins - since they have pleiotropic effects (favorable effects on endothelin and thrombus formation, plaque stabilization, and anti-inflammatory properties) and CIN has a vascular nature, then they can be renoprotective.

D. Ascorbic acid

E. The adenosine antagonists theophylline and aminophylline

F. Vasodilators

G. Forced diuresis using diuretics like mannitol.

H. Renal replacement therapy in the case of end stage renal failure

I. Prostaglandin E1

2. Identify the characteristic symptoms and signs of your patient with oliguria

These include:

A. Low urine output

B. Peripheral or generalized body swelling or edema.

C. Hypertension

D. Electrolyte imbalance

E. Shortness of breath

F. Pulmonary edema.

G. Confusion

H. Nausea

I. Chest pain

J. Seizures or Convulsions

3. Identify the cause of Prerenal, post-renal, and intrarenal AKI

A. Prerenal causes are those decrease effective blood flow to the kidney and cause a decrease in the glomerular filtration rate (GFR) and include:

•  low blood volume (e.g., dehydration)
•  low blood pressure
•  heart failure (leading to cardiorenal syndrome)
• hepatorenal syndrome in the context of liver cirrhosis
• Renal artery stenosis
• Renal vein thrombosis

Intrarenal cause include:

• glomerulonephritis
• acute tubular necrosis (ATN)
• acute interstitial nephritis (AIN). rhabdomyolysis
• tumor lysis syndrome.[10] Certain medication classes such as calcineurin inhibitors (e.g., tacrolimus)

Post renal causes include:

• benign prostatic hyperplasia
• kidney stones
• obstructed urinary catheter
• bladder stones
• cancer of the bladder, ureters, or prostate

4. Identify which patient would be a candidate for hemodialysis treatment

These include a patient with:

A. Severe fluid overload.

B. Refractory hypertension.

C. Uncontrollable hyperkalemia.

D. Intractable Nausea, vomiting, poor appetite, gastritis with hemorrhage.

E. Lethargy, malaise, somnolence, stupor, coma, delirium, asterixis, tremor, seizures

F. Pericarditis (risk of hemorrhage or tamponade

G. Severe metabolic acidosis

H. bleeding diathesis (epistaxis, gastrointestinal (GI) bleeding

I. Blood urea nitrogen (BUN) > 70-100 mg/dl

J. Progressive uremic encephalopathy or neuropathy

K. Heavy metal poisoning like lead poisoning.

5. Identify the normal and abnormal findings on a urinalysis screen.

Abnormal findings on a urinalysis screen include high glucose, high protein, bilirubin, red blood cells, white blood cells, crystals, and bacteria

Others include cloudy red or orange urine, acidic or alkaline pH, casts and crystals, high nitrite levels and ketones

Normal findings include

A. Very low levels of protein

B. Very low levels of sugar

C. Normal pH 7.35-7.45

D. Colorless or amber color

E. Urine specific gravity between 1.003-1.030

F. Osmolality of 400mOsm/kg