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Renal > 05.15 - AKI (Canada) - PP > Flashcards

05.15 - AKI (Canada) - PP Flashcards

1
Q

3 Clinical Clues to ATN

A

(1) Muddy brown granular casts; (2) Urine Na > 20; (3) Fractional excretion of Na > 1%

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2
Q

Urinarlysis in Hepatorenal Syndrome

A

Usually normal

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2
Q

Urine Na in HRS

A

Very low (Aldosterone)

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2
Q

Urine in Acute Interstitial Nephritis

A

Pyuria +/- eosinophils

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3
Q

Effect of Aminoglycosides on Kidney

A

Inhibits normal lysosomal function, accumulates in PT cells

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4
Q

What can you do in suspected HRS to rule out simple pre-renal condition

A

Trial of volume (usually Albumin) infusion

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5
Q

Urine [Na] and Osm in Pre-Renal AKI

A

Very low Na (Aldosterone overactive), Very high osmolarity (ADH overactive)

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5
Q

Why is urine Na high in ATN

A

Necrotic tubular cells can’t reabsorb Na so excreted

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6
Q

___ can cause form of pre-renal AKI in patients with Bilateral RAS

A

ACEi’s and ARB’s

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6
Q

Main 2 Causes of ATN

A

Ischemic injury; Toxic injury from contrast or meds

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6
Q

Symptoms of Acute Interstitial Nephritis in most patients now

A

Only renal dysfunction

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7
Q

2 Therapeutic agents that cause Pre-Renal AKI

A

NSAIDs, ACEi’s

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8
Q

What does survival in Hepatorenal Syndrome depend on

A

Liver transplant

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9
Q

How to avoid Contrast Nephropathy

A

Avoid closely spaced studies

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10
Q

Acute Kidney Injury is essentially

A

Impairment of GFR

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10
Q

BP and ECV in Hepatorenal Syndrome

A

Decrease BP despite incr ECFV (decr ECV)

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10
Q

Histology of ATN

A

Tubular necrosis with denuding of renal tubular epithelial cells; Occlusion of tubular lumens with cells/casts

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10
Q

Acute Interstitial Nephritis is most commonly caused by

A

Beta Lactam Abx, NSAIDs

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12
Q

Most common cause of Post-renal AKI

A

Prostate disease

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12
Q

(1) Muddy brown granular casts; (2) Urine Na > 20; (3) Fractional excretion of Na > 1%

A

3 Clinical Clues to ATN

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14
Q

Worsening renal failure in setting of cirrhosis =

A

Hepatorenal syndrome

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15
Q

Must rule out what else to conclude HRS

A

NSAIDs, Nephrotoxic drugs, Contrast

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17
Q

BUN/Cr in Pre-Renal vs ATN

A

>20:1 in Pre-Renal; 10-15:1 in ATN

17
Q

Why is Uosm high in Pre-Renal and Normal in ATN

A

High Aldo in Pre-Renal; In ATN, necrotic cells can’t dilute or concentrate so same as blood

19
Q

Most common class of AKI? Second?

A

55% Pre-renal, 40% intrinsic

21
Q

Calyce visible on renal US means

A

Obstruction of outflow

22
Q

2 Aminoglycosides

A

Gentamycin, Topomycin

23
Q

How do contrast agents cause AKI

A

Direct vasoconstrictive effects on arterioles; Also directly toxic

25
Q

Usual symptoms of AKI

A

Usually asymptomatic and discovered on routine labs

26
Q

Why do ACEi’s cause Pre-Renal AKI

A

Inhibit Ang2 which selectively constricts efferent arterioles

27
Q

Oliguria is defined as

A

Less than 400mL / 24 hours

28
Q

Muddy Brown Casts =

A

ATN

28
Q

Management of Ischemic ATN

A

Treat underlying cause - Restore perfusion

29
Q

FENa in Pre-Renal vs ATN

A

Less 1% in Pre-Renal; Greater than 1% in ATN

31
Q

Timeframe of AKI

A

Rapid deterioration of kidney function < 1 month

32
Q

Hepatorenal syndrome results from what liver disease

A

Cirrhosis

33
Q

UNa+ in Pre-Renal vs ATN

A

Less than 20 mEq/L in Pre-Renal; Greater than 25 mEq/L in ATN

34
Q

How do you prevent Aminoglycoside toxicity

A

Once daily dosing; Minimize duration of tx

36
Q

Impairment of GFR (AKI) leads to

A

Elevation of BUN/Creatinine, Accumulation of substances/drugs normally excreted by kidney

37
Q

Inhibits normal lysosomal function in kidney

A

Aminoglycosides

38
Q

3 Specific Types of Pre-Renal AKI

A

(1) Hepatorenal Syndrome; (2) RAS and Ang2 blockers/ACEi’s; (3) Other drugs that impair autoregulation (NSAIDs)

39
Q

2 causes of Post-renal AKI other than prostate

A

Malignancies, Neurogenic bladder

40
Q

ACEi’s and ARB’s can cause ___ in patients with Bilateral RAS

A

Pre-Renal AKI

41
Q

Decreased levels or inhibition of Ang2 impairs renal ____

A

Auto-Regulation (constriction of efferent arterioles in RAS)

43
Q

Dx of Post-renal AKI

A

Foley catheter, US

45
Q

Uosm in Pre-Renal vs ATN

A

>500 mOsm/kg vs 300-350 mOsm/kg

46
Q

As BP falls, kidneys are able to maintain BP well, unless __

A

Ang2 blocker interferes with Efferent Arteriole vasoconstriction (impaired autoregulation)

47
Q

Urine output in AKI

A

Sometime decr, but not always

48
Q

Hyaline casts are seen in what type of kidney injury

A

Pre-renal AKI

50
Q

Most accurate test for Pre-Renal AKI

A

Fractional excretion of Na - If less than 1%, suggestive of pre-renal

51
Q

U/A in Pre-Renal vs ATN

A

Hyaline Casts vs Granular Casts

52
Q

Creatinine change criteria for AKI

A

Greater than 0.5mg/dL incr or incr of 50% over baseline

53
Q

Most important cause of Intra-renal AKI discussed

A

ATN

54
Q

Pre-Renal AKI is due to insufficiency of

A

Renal perfusion

55
Q

Urinalysis in Post-renal AKI

A

Unremarkable

56
Q

How do NSAIDS cause Pre-Renal AKI

A

Block PG’s that dilate the afferent arterioles

Renal (31 decks)

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