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Senior - GU Test 1 > 11 - Acute Kidney Injury > Flashcards

11 - Acute Kidney Injury Flashcards

1
Q

Azotemia is?

A

Abnormally high serum levels of nitrogenous substances

  • urea
  • creatinine

Nitrogen+emia = blood condition

Azotemia = nirogen in blood

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2
Q

Uremia is

A

Clinical syndrome that results from abnormally high serum levels of nitrogenous substances

Uremia = urine in blood

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3
Q

Azotemia and uremia?

A

Azotemia -> -> Uremia

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4
Q

Abrupt drop in GFR results in?

A

Inability to maintain acid/base or fluid/electrolyte balance

Inability to excrete nitrogenous waste

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5
Q

Nonspecific symptoms of AKI/AFR?

A

Due to azotemia or its underlying cause

- prolonged azotemia can cause uremic syndrome

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6
Q

Urine with AKI or ARF?

A

Volume
- <400-500 mL/day
- or <20mL/hr
= oliguria

Can also be impaired renal concentration
- high or normal volume

Rarely anuria

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7
Q

Marker for severity with AKI/ARF?

A

Serum cratnine concentratino increase by 1-1.5 mg/dL/day

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8
Q

As GFR decreasees?

A

Tubular secretion of Cr increases so

- in early disease stages a large reduction in GFR is necissary to rase serum creatinine

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9
Q

RIFLE criteria?

A 
Risk
Injury
Failure
Loss
ESRD
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10
Q

AKI/ARF categories?

A
  1. Prerenal causes
  2. Intrinsic renal disease
  3. Postrenal causes
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11
Q

1st step toward treating AKI/ARF?

A

Identifying the cause

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12
Q

MC cause of AKI?

A

Rerenal azotemia (40-80%)

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13
Q

Cause of prerenal azotemia?

A

Due to renal hypoperfusion

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14
Q

Why is the prognosis of prerenal azotemia

A

If reversed quickly w renal restoration of renal blood flow -> renal parenchymal damage is prevented

If hypoperfusion persists -> ischemia -> intrinsic renal injury

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15
Q

Causes of renal hypoperfusion with prerenal azotemia?

A
  • L intravascular volume
  • Change in vascular resistance
  • Low cardiac output

Basically: Hypovolemia and Shock

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16
Q

Decrease in intravascular volume can be caused by?

A
  • hemorrhage,
  • GI losses,
  • dehydration,
  • excessive diuresis,
  • extravascualr space sequestration,
  • pancreatitis,
  • burns,
  • trauma,
  • peritonitis
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17
Q

Change in vascular resistance can be caused by?

A
  • sepsis
  • anaphylaxis
  • anesthesis
  • afterload-reducing drugs
  • renal artery stenosis
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18
Q

Low cardiac output can be caused by?

A
  • Cariogenic shock
  • CHF
  • PE
  • pericardial tamponade
  • arrhythmia
  • valvular disorders
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19
Q

prerenal Azotemia + NSAIDS + ACEI can lead to?

A

Hypovolemia - reduced kidney perfusion
+
NSAIDS - block vasodilatary prostaglandins at Afferent arteriole
+
ACEI - prevent Efferent arteriole vasoconstrition
=
Acute Renal Failure

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20
Q

Pts with prerenal azotemia present with?

A

Dehydration from renal or extrarenal fluid losses

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21
Q

Labs for prerenal azotemia?

A

BUN: Creatinine ratio >20:1

H urine osmolality

Urinary sedement - bland or hylaine casts

Una <20 mEq/L

FEna <1%

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22
Q

What lab did he make a huge deal about?

A

BUN: creatinine ration > 20:1

Be able to calculate it

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23
Q

Differentiates prerenal and intrinsic renal disease?

A

FE(na) <1%

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24
Q

Tx for prerenal azotemia?

A
  • admit
  • achievement of euvolemia
  • fix serum electrolytes
  • NO NEPHROGENIC DRUGS
  • monitor unrine output (should go up)
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25
Least common cause of AKI?
POSTrenal azotemia (5-10%)
26
Why is it important to detect POSTrenal azotemia?
It is reversible (if you find it) Its obstructed urinary flow
27
Pathophys of Postrenal azotemia?
Obstruction - > H intraluminal pressure - > parenchymal damage - > L GFR
28
Causes of postrenal azotemia?
Obstruction of both ureters/renal pelvises Bladder dysfunction/obstruction Urethral obstruction -
29
MC cause of urethral obstruction in men?
BPH
30
Other causes of postrenal azotemia?
- anticholinergic meds - cancer - retroperitoneal fibrosis - neurogenic bladder -
31
Less common causes of postrenal azotemia?
- blood clots - bilateral ureteral stones - urethral stones/stricture - bilateral papillary necrosis
32
Presentation of postrenal azotemia?
Anuria or Polyuria | Lower abd pain
33
PE for postrenal azotemia?
Enlarged prostate Pelvic mass Distended bladder
34
Labs for postrenal azotemia?
- BUN:creatinine ratio >20:1 - H urine osmolality -> later L urine osmolality - urine sediment: bland (benign) - Fe(na) variable - U(na) variable
35
Tx for postrenal azotemia?
- Admit - bladder catheterization - find cause (US, CT, MRI) - correct obstruction - postobstructive diuresis
36
After relieving long-term bladder outlet obstruction beware of?
Postobstructive diuresis -> hypovolemia
37
After pre and post renal causes are excluded look at?
Intrinsic renal disease
38
Sites of injury that cause intrinsic renal disease?
- tubules - interstitium - vasculature - glomeruli
39
Acute tubular necrosis (ATN) =?
AKI/ARF due to tubular damage | - 85% of intrinsic AKI/ARF
40
Major causes of ATN?
Ischemia | Nephrotoxin exposure
41
What is ischemic ATN?
Tubular damage due to low perfusion -> tubular necrosis and apoptosis - begins as prerenal azotemia
42
Ischemic ARF is characterized by?
Inadequate GFR Inadequate renal blood flow - inability to maintain parenchymal cellular perfusion
43
Ischemic ATN occurs?
In the setting of prolonged HOTN or hypoxemia | - (volume depletion, shock, trauma etc)
44
Nephrotoxic ATN causes?
Exogenous (MC) | Endogenous
45
Exogenous nephrotoxins?
``` Aminoglycosides Vanc Amphotericin B IV acyclovir Cephalosporins Radiographic contrast Cyclosporine Antineoplastics Heavy metals ```
46
Endogenous nephrotoxins?
``` Heme-containing/mimicking products - myoglobin (rhabdo) - hemoglobin (intravascular hemolysis) Uric acid (hypouriecmia) - rapid cell turnover and lysis (chemo) Paraproteins - bence jones protein (multiple myeloma) ```
47
ATN presentation?
``` Gen swelling N/V Oliguria Signs of Hypovolemia decreased LOC Anorexia Gi bleed Muscle weakness/twitching ```
48
ATN labs?
``` Active urine sediment - muddy brown cysts - renal tubular epithelial cysts/casts Urine output: oliguric/nonoliguric BUN:creat <20:1 UA(na) >20 FE(na) >1-2% Hyperkalemia Hyperphosphatemia (Common) ```
49
Tx for ATN
``` Admit ICU Avoid volume overload - dieuritics - monitor pulmonary edema Mantai fluid electrolyte and acid/base - avoid hyperK Nutritional support - protein restriction Dialysis ```
50
ATN tx indication for dialysis
``` Life-threat electrolyte disturbancy Volume overolad unresponsive to diuretics Worsening acidosis Uremic complications - encephalopathy, pericarditis, seizures ```
51
3 phases (clinical course) of ATN?
Initial injury Maintenance (1-3 wks or months) Recover - heralded by diuresis
52
Mortality with ATN?
Varies 20-70% Causes - infection - fluid/electrolyte disturbances - worsening underlying disease
53
Acute interstitial nephritis (AIN) essentials for diagnosis?
``` Fever Transient maculopapular rash Acute renal insufficiency Pyruria (eosinophils) - WBC casts Hematuria ```
54
Causes of AIN?
Drugs (70%) Infectious diseases Idiopathic conditions Full list on 41
55
AIN presentation
Fever (80%) Rash Arthralgias Peripheral blood eosinophilia (80%)
56
Classic triad of AIN?
Fever Rash Arthralgias 10-15% of cases
57
AIN labs?
``` Bun:creat <20:1 UA - RBC - WBC - WBC casts - eosinophiluria Proteinura Peripheral blood smear: eosinophilia ```
58
AIN tx?
– Nephrology consult – Supportive measures – Removal of inciting agent – If renal failure persists → short course of steroids – Good prognosis w/ recovery usually w/in weeks-months – Acute dialysis therapy may be necessary in 1/3 of patients • Rarely progress to ESRD
59
Vascular ARF causes?
Renal vein thrombosis Renal infarction Malignant HTN
60
Acute glomerulonephritis and AKI/ARF?
Uncommon cause - 5%
61
Essentials for diagnosis w acute glomerulonephritis?
hematuria - dysmorphic RBC - RBC casts - mild proteinuria Dependent edema and HTN Acute renal insufficiency
62
Intrinsic renal disease comparison?
Slide 46 Might be a good one
63
Homeopathic surgery
“Quick nurse, hand me nothing”

Senior - GU Test 1 (13 decks)

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