Preview Mode Links will not work in preview mode

Ridgeview and the Ridgeview Continuing Medical Education Program are proud to present the Ridgeview Podcast: CME Series; a quality, portable and on-demand continuing medical education, that features a variety of exceptional physicians, providers and other staff from Ridgeview and it's affiliates. Hosts of the program are Fred DeMeuse, PA-C, Jason Hicks, PA-C, and Leah Radde, RN. Thanks for tuning-in, downloading and listening! 

 

DISCLOSURE ANNOUNCEMENT 

The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview & Ridgeview Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws. 

It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented.

Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event.

Mar 11, 2022

In this podcast, we are joined by Dr. Kim Thielen, a nephrologist/kidney specialist with Minnesota Kidney Specialists. This episode is part one of a two part series dealing with acute kidney injuries. During this episode Dr. Thielen will discuss pre and post acute kidney injury etiologies. Included with the podcast is additional shownotes that Dr. Thielen references throughout the podcast.  Also check out the next podcast/episode on intrinsic kidney injuries.

Enjoy the podcast!

Objectives:
  Upon completion of this podcast, participants should be able to:

  • Describe how to work up a patient who presents with kidney injury.
  • State the 3 types of kidney injury etiologies.
  • Identify various causes of kidney injury.
  • Choose treatment options for the specific types of kidney injury.

CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org.

To receive continuing education credit for this activity - click the link below, to complete the activity's evaluation.

CME Evaluation

(**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) 

DISCLOSURE ANNOUNCEMENT 

The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws. 

It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented.

Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event.

Thank-you for listening to the podcast.

SHOW NOTES: 
*See the attachment for additional show information.
  
Acute Kidney Injury

- Abrupt decrease in kidney function
- Suspected with oliguria, elevated creatinine, proteinuria, and hematuria

Oliguria
- Less than 500mls of urine in 24 hour period.

PreRenal
- Anything that decreases circulating volume or disruption of blood flow to the kidney, causing ischemic kidney
- Causes:
    - Total body salt and water depletion
    - Dehydration
    - Hemorrhage
    - Decompensated right or left ventricular failure
    - Renal arterial stenosis or renal vasospasm

Signs and Symptoms
- Orthostatic, hypotensive, tachycardiac
- Most sensitive indicator of ischemic kidney: Urinary sodium concentration

Urinary Sodium Concentration
- Distinguishes between prerenal and instrinsic causes
- Urine sodium less than 20 in oliguria is indicator of ischemic kidney

Fractional Excretion of Sodium
- Fractional excretion of less than 1% is indicative of ischemic kidney or a prerenal state
- Fractional excretion of 2% is indicative of tubulules not working or ATN

Fractional Excretion of Urea
- For patients on diuretics
- Urea not affected by water concentrating effect of kidney
- Prerenal state: fractional excretion of urea less than 35
- Intrinsic: fractional excretion of urea greater than 35

Classic Presentation of Prerenal
- BUN to Creatinine Ratio greater than 20.1 signifies dehydration
      - Variables: GI bleed can increase BUN
- Elevated bicarb

Post Renal Etiologies
- Anything that interfers with the drainage of the urine from the renal pelvis out to the urethra.
- Causes:
      - Intraluminal obstruction: stones or tumors
      - Dysfunctional bladder: spinal injury, diabetes
             - Dysfunction with bladder drainage
      - Extrinsic compression on ureter
               - Ruptured AAA: edema
               - Retroperitoneal fibrosis
               - Prostate
               - Urethral strictures

Post Renal Presentation
- Can present with pain or not
- Decreased urine output or outflow
- Hypertensive
- Volume overload

Treatment
- Foley distal obstructions of urethra
- Imaging: ultrasound
       - Horizontal view:
              - Normal: (bright white) collecting system is collapsed due to normal drainage of pelvis
              - Post renal obstruction
                      - Dilated (dark pools) collecting system
- Chronic obstruction
       - Functional dilatation
       - Further testing: functional lasix radiograph
       - Kidney transplant: functional dilated picture
              - Changed physiology of the ureter, and can get flow both ways and thus chronic dilation

Thanks for listening.