Explain the major causes of prerenal, postrenal, and ...

[nmorano1]

Explain the major causes of prerenal, postrenal, and intrarenal/intrinsic AKI. Identify the staging for AKI. What do you suspect is the major etiology of Mr. Maddox's AKI?
 
  What will be an ideal response?

Question 2

List the risk factors for developing hypertension. What risk factors does Mrs. Moore currently have? Discuss the contribution of ethnicity to hypertension, especially for African Americans
 
  What will be an ideal response?

[potomatos]

Answer to Question 1

Typically, AKI is characterized by a rapid decline in kidney function with an acute elevation of serum creatinine at baseline. There are three types of causes for the kidney dysfunction:
 Prerenal:
- An underlying condition deprives the kidneys of necessary blood flow and decreases the GFR.
- Due to: volume depletion (e.g. via the GI tract or extensive wounds), hypotension/shock, CHF, renal vasoconstriction from medications or hepatorenal issues, and renal artery occlusion from an embolism or thrombosis.
- If blood flow is not restored, necrosis of the cells will occur.
 Intrarenal/Intrinsic:
- Occurs when parts of the kidneys such as the tubule, the interstitium, the glomerulus, or the vasculature are damaged (true kidney problem).
- Underlying conditions that can lead to kidney damage include hypertension, interstitial inflammation from an infection or disease (e.g. lupus, Goodpasture syndrome, acute glomerulonephritis), acute tubular necrosis, acute interstitial nephritis, nephrotoxicity, or intrarenal obstruction.
 Postrenal: Results when crystals, protein deposits, blood clots, or malignant tumor infiltration obstruct urine flow.
 There are typically 4 stages involved with AKI:
- Initiation: when GFR declines
- Extension: when ischemia and inflammatory damage occur
- Maintenance: when GFR is at its lowest level
- Recovery: when epithelial cells regenerate
Mr. Maddox is most likely experiencing AKI due to a deprivation of blood (oxygenation) during recovery from surgery as it was noted that he had a sudden drop of blood pressure. The infection following his CABG  3, which may have lead to inflammation and therefore kidney damage, may also have been a contributing factor.

Answer to Question 2

 Overweight or obesity
 Smoking/second-hand smoke
 Physical inactivity
 Excessive salt consumption
 Too little potassium and vitamin D
 Low intakes of potassium, magnesium, and calcium
 Excessive alcohol consumption
 Stress
 Race or ethnicity (African American, Hispanic) African Americans (43 for males and 45.7 for females), Filipinos, and South Asians have a higher prevalence of hypertension; Mexican American have lower reported rates
 Genetics
 Aging
 Certain chronic diseases: diabetes, kidney disease, sleep apnea, hypercholesterolemi a, atherosclerosis
 Mrs. Moore risk factors include:
- Family history
- African American ancestry
- Excessive salt consumption
- Alcohol consumption (although not excessive)
- Overweight
- Smoker (quit 1 year ago)

[nmorano1]

Both answers were spot on, thank you once again

[potomatos]

Great! Please up vote